Healthcare Provider Details

I. General information

NPI: 1629051925
Provider Name (Legal Business Name): NATHANIEL KENNETH DUFF PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

337-B KIHAPAI ST.
KAILUA HI
96734
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-3185
  • Fax: 808-433-5550
Mailing address:
  • Phone: 808-228-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberAMD-269
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: