MEDICARE: THI-MINH THAO GUPPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN-95786	HI

General Provider Information

NPI Number	:	1023617651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THI-MINH THAO GUPPY

Provider Business Mailing Address
First Line	:	735 OHANA NUI CIR
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-4476
Country	:	US
Telephone Number	:	757-788-4285
Fax Number	:

Provider Business Practice Location Address
First Line	:	4559 KILAUEA AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5046
Country	:	US
Telephone Number	:	808-208-1629
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2020
Last Update Date	:	10/24/2020

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