=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306543830
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY BETH VICTORIA RAYNARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2023
-----------------------------------------------------
Last Update Date | 04/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98-697 KEIKIALII ST
-----------------------------------------------------
City | AIEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96701-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-595-0111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 98-697 KEIKIALII ST
-----------------------------------------------------
City | AIEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96701-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-595-0111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374700000X
-----------------------------------------------------
Taxonomy Name | Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------