MEDICARE: WITNIE PACHECO

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-95114	HI

General Provider Information

NPI Number	:	1114576204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WITNIE PACHECO

Provider Business Mailing Address
First Line	:	91-1031 KAIMALIE ST APT 4V6
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6020
Country	:	US
Telephone Number	:	808-295-4045
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-1031 KAIMALIE ST APT 4V6
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6020
Country	:	US
Telephone Number	:	808-295-4045
Fax Number	:

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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Directions to “ WITNIE PACHECO ” Practice Location

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