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General NPI Number Information
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NPI Number | 1063307080
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Entity Type | Organization
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Legal Business Name | JODI OLDFATHER, CRNA LLC
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 82 PUUHONU PL STE 100
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City | HILO
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State | HI
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Zip | 96720-2010
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Country | US
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Telephone | 808-969-9669
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Fax |
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Provider Business Mailing Address
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Address Line | 99 PILIALOHA ST
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City | HILO
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State | HI
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Zip | 96720-1865
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Country | US
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Telephone | 808-282-5317
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JODI OLDFATHER
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Credential | CRNA
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Telephone | 808-282-5317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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