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General NPI Number Information
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NPI Number | 1790006286
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Entity Type | Individual
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Provider Name | AMANDA MARN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 210 IMI KALA ST STE 209
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City | WAILUKU
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State | HI
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Zip | 96793-1274
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Country | US
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Telephone | 808-673-5778
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Fax |
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Provider Business Mailing Address
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Address Line | 210 IMI KALA ST STE 209
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City | WAILUKU
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State | HI
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Zip | 96793-1274
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Country | US
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Telephone | 808-673-5778
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 85491-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | MD-20631
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD-20631
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License Number State | HI
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