Healthcare Provider Details

I. General information

NPI: 1922650555
Provider Name (Legal Business Name): KAITLYN ISSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 HANALEI PLANTATION RD
PRINCEVILLE HI
96722-5462
US

IV. Provider business mailing address

4488 HANALEI PLANTATION RD
PRINCEVILLE HI
96722-5462
US

V. Phone/Fax

Practice location:
  • Phone: 808-378-2220
  • Fax:
Mailing address:
  • Phone: 808-378-2220
  • Fax: 808-930-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2825
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: