MEDICARE: DR. VANESSA HULALI EAGLIN M.D.

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	2084P0800X	Psychiatry Physician	13368	HI

General Provider Information

NPI Number	:	1194931196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA HULALI EAGLIN M.D.

Provider Business Mailing Address
First Line	:	73 PUUHONU PL
Second Line	:	SUITE 200
City	:	HILO
State	:	HI
Zip	:	96720-2060
Country	:	US
Telephone Number	:	808-969-7922
Fax Number	:	808-934-2037

Provider Business Practice Location Address
First Line	:	73 PUUHONU PL
Second Line	:	SUITE 200
City	:	HILO
State	:	HI
Zip	:	96720-2060
Country	:	US
Telephone Number	:	808-969-7922
Fax Number	:	808-934-2037

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	01/12/2009

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