Healthcare Provider Details

I. General information

NPI: 1417507229
Provider Name (Legal Business Name): ANJULIE LYNE DAVID MORALES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92-2466 OHIA DRIVE
OCEAN VIEW HI
96737
US

IV. Provider business mailing address

PO BOX 509
NAALEHU HI
96772-0509
US

V. Phone/Fax

Practice location:
  • Phone: 808-747-0355
  • Fax:
Mailing address:
  • Phone: 808-747-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number81224
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: