Healthcare Provider Details

I. General information

NPI: 1922398163
Provider Name (Legal Business Name): SUWAN KHAMKHUN MCGRATH A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 KILOU ST
WAILUKU HI
96793-9753
US

IV. Provider business mailing address

1370 KILOU ST
WAILUKU HI
96793-9753
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-7235
  • Fax: 808-242-7235
Mailing address:
  • Phone: 808-242-7235
  • Fax: 808-242-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN - 1249
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: