Healthcare Provider Details

I. General information

NPI: 1609093244
Provider Name (Legal Business Name): KIMBERLY ELLEN DUBOIS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG.1407- MAKALAPA ROAD
PEARL HARBOR HI
96814-3610
US

IV. Provider business mailing address

47-291 HUI IWA ST UNIT C
KANEOHE HI
96744-4330
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-0247
  • Fax:
Mailing address:
  • Phone: 808-590-1728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number55912
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: