Healthcare Provider Details

I. General information

NPI: 1497742696
Provider Name (Legal Business Name): WENDY MUTCHLER MCCRAW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 09/11/2025
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

480 CENTRAL AVE
PEARL HARBOR HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-2777
  • Fax: 808-473-2473
Mailing address:
  • Phone: 808-473-2777
  • Fax: 808-473-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001163194
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number197568
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: