Healthcare Provider Details

I. General information

NPI: 1528106481
Provider Name (Legal Business Name): RINA SUPNET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 FOURTH ST
PEARL CITY HI
96782-3312
US

IV. Provider business mailing address

1700 LANAKILA AVE
HONOLULU HI
96817-2115
US

V. Phone/Fax

Practice location:
  • Phone: 808-453-5950
  • Fax: 808-453-5966
Mailing address:
  • Phone: 808-832-3823
  • Fax: 808-832-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN 55135
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: