Healthcare Provider Details

I. General information

NPI: 1487767836
Provider Name (Legal Business Name): ANNE ELIZABETH POLLOCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-2866 PAHOA VILLAGE RD BLDG C
PAHOA HI
96778-7720
US

IV. Provider business mailing address

75-5751 KUAKINI HWY STE 203
KAILUA KONA HI
96740-1753
US

V. Phone/Fax

Practice location:
  • Phone: 808-333-3600
  • Fax:
Mailing address:
  • Phone: 808-333-3600
  • Fax: 808-961-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2745
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA102923
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberA102923
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: