Healthcare Provider Details

I. General information

NPI: 1851369565
Provider Name (Legal Business Name): ELAINE MARIE WILLIAMS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MAUILANI PKWY STE 100
WAILUKU HI
96793-2443
US

IV. Provider business mailing address

105 MAUILANI PKWY STE 100
WAILUKU HI
96793-2443
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-9555
  • Fax: 808-244-9577
Mailing address:
  • Phone: 808-244-9555
  • Fax: 808-244-9577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA-1332-05
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number1208
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: