Healthcare Provider Details

I. General information

NPI: 1871458059
Provider Name (Legal Business Name): JOSETTE ENOMOTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 WAIEHU BEACH RD STE 115
WAILUKU HI
96793-1472
US

IV. Provider business mailing address

240 KILIOOPU ST
WAILUKU HI
96793-4184
US

V. Phone/Fax

Practice location:
  • Phone: 808-298-7553
  • Fax:
Mailing address:
  • Phone: 808-298-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN69374
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: