Healthcare Provider Details

I. General information

NPI: 1639877004
Provider Name (Legal Business Name): COURTNEY OLAYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. COURTNEY LEE RHOADS

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 KAMEHAMEHA HWY
PEARL CITY HI
96782-2753
US

IV. Provider business mailing address

91-972 OANIANI ST
KAPOLEI HI
96707-2627
US

V. Phone/Fax

Practice location:
  • Phone: 808-260-0809
  • Fax:
Mailing address:
  • Phone: 808-260-0809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: