Healthcare Provider Details

I. General information

NPI: 1821452442
Provider Name (Legal Business Name): MERRILY DIVINE DALY RN, LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MOKUAHI ST
MAKAWAO HI
96768-8963
US

IV. Provider business mailing address

165 MOKUAHI ST
MAKAWAO HI
96768-8963
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 808-280-2077
  • Fax: 808-442-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number21789
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number00040004
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number5
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number21789
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: