Healthcare Provider Details

I. General information

NPI: 1316124175
Provider Name (Legal Business Name): SUSAN YEE-LOH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CENTER ST
WAHIAWA HI
96786-2038
US

IV. Provider business mailing address

1044 ALEWA DR
HONOLULU HI
96817-1504
US

V. Phone/Fax

Practice location:
  • Phone: 808-621-6511
  • Fax:
Mailing address:
  • Phone: 808-595-9198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number498
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: