Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | APRN-3369 | HI |
NPI | 1013672435 |
---|---|
Provider Name | Keohikai Michael Laikupu |
First Address | Keaau, HI 96749-2412 |
Second Address | Keaau, HI 96749-9674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2021 |
Last Update Date | 01/11/2021 |