MEDICARE: PAMELA KEANINI

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	163WP0200X	Pediatric Registered Nurse	43183	HI

General Provider Information

NPI Number	:	1821653064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA KEANINI

Provider Business Mailing Address
First Line	:	94-450 MOKUOLA ST
Second Line	:
City	:	WAIPAHU
State	:	HI
Zip	:	96797-3388
Country	:	US
Telephone Number	:	808-944-2882
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-2198 KANELA ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-5962
Country	:	US
Telephone Number	:	808-722-9061
Fax Number	:

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

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	05/02/2019

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Directions to “ PAMELA KEANINI ” Practice Location

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