Healthcare Provider Details

I. General information

NPI: 1699968362
Provider Name (Legal Business Name): PACIFIC BREEZE GYN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4473 PAHEE ST SUITE R
LIHUE HI
96766-2037
US

IV. Provider business mailing address

PO BOX 3949
LIHUE HI
96766-6949
US

V. Phone/Fax

Practice location:
  • Phone: 808-245-7100
  • Fax: 808-245-9881
Mailing address:
  • Phone: 808-245-7100
  • Fax: 808-245-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: DONNA FARLEY
Title or Position: CNM
Credential: CNM
Phone: 808-245-7100