Healthcare Provider Details

I. General information

NPI: 1013672435
Provider Name (Legal Business Name): KEOHIKAI MICHAEL LAIKUPU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SACO AVE STE 2A
OLD ORCHARD BEACH ME
04064-1623
US

IV. Provider business mailing address

155 SACO AVE STE 2A
OLD ORCHARD BEACH ME
04064-1623
US

V. Phone/Fax

Practice location:
  • Phone: 207-937-8254
  • Fax: 844-824-7835
Mailing address:
  • Phone: 207-937-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCNP-221606
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-83873
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN-3369
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-87374
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: