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General NPI Number Information
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NPI Number | 1366571101
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Entity Type | Individual
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Provider Name | BYRON VON ROOT RN
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 1301 PUNCHBOWL ST
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City | HONOLULU
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State | HI
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Zip | 96813-2402
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Country | US
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Telephone | 808-691-4386
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Fax | 808-537-7366
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Provider Business Mailing Address
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Address Line | 2404 BURBANK ST
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City | HONOLULU
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State | HI
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Zip | 96817-1431
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Country | US
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Telephone | 808-590-2283
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 28522
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License Number State | HI
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