Healthcare Provider Details

I. General information

NPI: 1609867951
Provider Name (Legal Business Name): INEZ REMIGIO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TAMC HI
96859-5001
US

IV. Provider business mailing address

1576 LAULANI ST
HONOLULU HI
96819-3813
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-5736
  • Fax:
Mailing address:
  • Phone: 808-845-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2685
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: