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General NPI Number Information
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NPI Number | 1669462198
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Entity Type | Individual
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Provider Name | SUSAN JOY KOHNKE APRN
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Gender | Female
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 77-6346 ALII DR
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City | KAILUA KONA
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State | HI
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Zip | 96740-2406
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Country | US
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Telephone | 443-691-9755
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 452
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City | HOLUALOA
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State | HI
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Zip | 96725-0452
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R136333
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN1245
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License Number State | HI
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