Healthcare Provider Details

I. General information

NPI: 1194042101
Provider Name (Legal Business Name): MS. JOSEPHINE SIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89B HANA HIGHWAY
PAIA HI
96779
US

IV. Provider business mailing address

3237 LUAHINE PL.
HAIKU HI
96708
US

V. Phone/Fax

Practice location:
  • Phone: 808-214-3691
  • Fax:
Mailing address:
  • Phone: 808-214-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number9142
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: