Healthcare Provider Details

I. General information

NPI: 1538569124
Provider Name (Legal Business Name): LUISA OGAWA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAUI LANI PKWY
WAILUKU HI
96793-2416
US

IV. Provider business mailing address

94 KUUKAMA ST
KAHULUI HI
96732-3132
US

V. Phone/Fax

Practice location:
  • Phone: 808-243-6681
  • Fax: 808-243-6689
Mailing address:
  • Phone: 808-269-4682
  • Fax: 808-873-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN1780
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: