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Organization

MAKANA O KA OLA HEALTH AND WELLNESS CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
STACEY LYN PRUSKY APRN FNP (OFFICER)
(360) 560-3801
Entity
Organization

Contact information

Practice address
1935 MAIN ST, SUITE 102, WAILUKU, HI 96793-1784
(360) 560-3801
Mailing address
1935 MAIN ST, SUITE 102, WAILUKU, HI 96793-1784
(360) 560-3801

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
119306444801
HI

Other

Enumeration date
10/19/2016
Last updated
10/19/2016
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