Basic Information
| Provider Information | |||||||||
| NPI: | 1043203417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLZ | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2180 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967931666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082426464 | ||||||||
| FaxNumber: | 8082424292 | ||||||||
| Practice Location | |||||||||
| Address1: | 2180 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967931666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082426464 | ||||||||
| FaxNumber: | 8082424292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 02/19/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 2001-PA13 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | AMD-301 | 01 | HI | HI LIC. | OTHER | A00120 | 01 | HI | STATE NARC. | OTHER | B9135 | 05 | NM | MEDICAID |