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General NPI Number Information
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NPI Number | 1538609201
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Entity Type | Organization
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Legal Business Name | MEDICAL HOUSECALLS HAWAII
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 834 KILAUEA AVE
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City | HILO
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State | HI
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Zip | 96720-4215
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Country | US
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Telephone | 808-961-5696
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Fax | 808-961-6461
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Provider Business Mailing Address
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Address Line | PO BOX 10305
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City | HILO
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State | HI
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Zip | 96721-5305
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Country | US
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Telephone | 808-961-5696
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Fax | 808-961-6461
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Authorized Official
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Title or Position | CEO
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Name | DR. ELLEN HARRIS
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Credential | DNP
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Telephone | 808-724-0177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1517
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License Number State | HI
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