Healthcare Provider Details

I. General information

NPI: 1831186121
Provider Name (Legal Business Name): MARIE RIVERA MACASPAC R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE NAVAL HEALTH CLINIC HAWAII
PEARL HARBOR HI
96860-4908
US

IV. Provider business mailing address

480 CENTRAL AVE NAVAL HEALTH CLINIC HAWAII
PEARL HARBOR HI
96860-4908
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number38631
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: