Organization
KA HOAILONA RURAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY LOUISE HOFFMAN FNP (OWNER)
80855343668
Entity
Organization
Contact information
Practice address
107B ALA MALAMA ST, KAUNAKAKAI, HI 96748
(808) 553-4368
(888) 388-2307
Mailing address
PO BOX 1509, KAUNAKAKAI, HI 96748-1509
(808) 553-4368
(888) 388-2307
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
865
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FW296A
MEDICARE PTAN
HI
Enumeration date
03/08/2012
Last updated
01/14/2015
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