=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467099481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NP PROVIDER1, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2019
-----------------------------------------------------
Last Update Date | 06/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46-064 ALIIKANE PL APT 2022
-----------------------------------------------------
City | KANEOHE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96744-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-208-0434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46-064 ALIIKANE PL APT 2022
-----------------------------------------------------
City | KANEOHE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96744-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-208-0434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. ELUNED MUN
-----------------------------------------------------
Credential | APRN-RX
-----------------------------------------------------
Telephone | 808-208-0434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------