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General NPI Number Information
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NPI Number | 1013598200
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Entity Type | Organization
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Legal Business Name | NAHALE FAMILY CLINIC
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 77-6403 NALANI ST UNIT 1
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City | KAILUA KONA
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State | HI
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Zip | 96740-9763
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Country | US
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Telephone | 808-376-1665
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28
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City | KAILUA KONA
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State | HI
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Zip | 96745
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Country | US
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Telephone | 801-706-6726
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEANNIE CLEMENT
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Credential |
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Telephone | 801-706-6726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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