Organization
PUKALANI FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DAYAJI GREEN (OFFICE MANAGER)
(808) 573-8900
Entity
Organization
Contact information
Practice address
81 MAKAWAO AVE STE 100, MAKAWAO, HI 96768-8859
(808) 573-8900
(808) 573-7505
Mailing address
81 MAKAWAO AVE STE 100, MAKAWAO, HI 96768-8859
(808) 573-8900
(808) 573-7505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Enumeration date
12/22/2020
Last updated
12/22/2020
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