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General NPI Number Information
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NPI Number | 1760276174
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Entity Type | Organization
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Legal Business Name | REJUVENATE HAWAII
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 82 PUUHONU PL STE 100
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City | HILO
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State | HI
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Zip | 96720-2010
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Country | US
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Telephone | 808-969-9669
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 260
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City | KURTISTOWN
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State | HI
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Zip | 96760-0260
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Country | US
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Telephone | 808-346-1854
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Fax |
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Authorized Official
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Title or Position | MANAGER, ANESTHESIOLOGIST EMPLOYEE
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Name | DR. SHANNON L BIANCHI
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Credential | MD
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Telephone | 808-765-0378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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