=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275830069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3 SISTERS INCONTINENT SUPPLIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2011
-----------------------------------------------------
Last Update Date | 02/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94-109 POLUHI WAY
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-5806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-429-4557
-----------------------------------------------------
Fax | 808-888-4910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94-109 POLUHI WAY
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-5806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-429-4557
-----------------------------------------------------
Fax | 808-888-4910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. RO-AN S SOLIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-429-4557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | W1322715301
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------