Organization
HAWAII DERMATOPATHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY KERSTEN REISENAUER MD (LAB DIRECTOR/OWNER)
(808) 264-2293
Entity
Organization
Contact information
Practice address
1300 N HOLOPONO ST STE 214, KIHEI, HI 96753-6945
(808) 874-3444
Mailing address
1300 N HOLOPONO ST STE 214, KIHEI, HI 96753-6945
(808) 874-3444
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
12D2120536
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12D2120536
CLIA
HI
Enumeration date
01/13/2017
Last updated
07/21/2022
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