Healthcare Provider Details

I. General information

NPI: 1598839060
Provider Name (Legal Business Name): DAWN EILEEN GROVES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE
PEARL HARBOR HI
96860-4908
US

IV. Provider business mailing address

95-1491 AINAMAKUA DR #7
MILILANI HI
96789-4401
US

V. Phone/Fax

Practice location:
  • Phone: 808-471-2214
  • Fax: 808-474-3120
Mailing address:
  • Phone: 808-626-1010
  • Fax: 808-626-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number40906
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: