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General NPI Number Information
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NPI Number | 1578348751
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Entity Type | Organization
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Legal Business Name | HOOMALIE PSYCHIATRY LLC
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 673 KAAKOLU ST
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City | LAHAINA
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State | HI
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Zip | 96761-1341
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Country | US
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Telephone | 808-281-9342
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Fax | 808-481-0010
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Provider Business Mailing Address
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Address Line | PO BOX 1154
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City | MAKAWAO
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State | HI
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Zip | 96768-1154
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Country | US
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Telephone | 808-281-9342
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Fax | 808-481-0010
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Authorized Official
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Title or Position | PMHNP
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Name | DEBRA M BATES
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Credential | NURSE PRACTITIONER
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Telephone | 808-281-9342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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