=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275865487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICOLE LITTENBERG MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2010
-----------------------------------------------------
Last Update Date | 01/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 WARD AVE STE 700
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-544-2645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 WARD AVE STE 700
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-544-2645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NICOLE LITTENBERG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-544-2645
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD-12561
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------