=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285106054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CELESTE HAUNANI SISON NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2018
-----------------------------------------------------
Last Update Date | 12/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 S KING ST STE 1105
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-205-5491
-----------------------------------------------------
Fax | 808-333-3682
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95-1123 LALAI ST
-----------------------------------------------------
City | MILILANI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96789-3716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-386-8208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN-2588
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------