Healthcare Provider Details

I. General information

NPI: 1093816563
Provider Name (Legal Business Name): NINA VISHNEVSKA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KAHAKAPAS ROAD
MAKAWAO HI
96768
US

IV. Provider business mailing address

PO BOX 536
MAKAWAO HI
96768
US

V. Phone/Fax

Practice location:
  • Phone: 808-572-9693
  • Fax:
Mailing address:
  • Phone: 808-572-9693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG37292
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD5087
License Number StateHI

VIII. Authorized Official

Name: NINA VISHNEVSKA
Title or Position: PRESIDENT
Credential: MD
Phone: 808-572-9693