Healthcare Provider Details

I. General information

NPI: 1114580818
Provider Name (Legal Business Name): CHARLOTTE Z GRANT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-502 KIPAPA DR
MILILANI HI
96789-1426
US

IV. Provider business mailing address

94-450 MOKUOLA ST STE 100
WAIPAHU HI
96797-3388
US

V. Phone/Fax

Practice location:
  • Phone: 808-627-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number56533
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: