=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225617467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORA PHILLIPS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2021
-----------------------------------------------------
Last Update Date | 04/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 935 CALIFORNIA AVE STE B17
-----------------------------------------------------
City | WAHIAWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96786-2166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-778-7286
-----------------------------------------------------
Fax | 808-278-6398
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2622 NONOHE ST
-----------------------------------------------------
City | WAHIAWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96786-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-778-7286
-----------------------------------------------------
Fax | 808-278-6398
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NORA A PHILLIPS
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 808-778-7286
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------