Basic Information
| Provider Information | |||||||||
| NPI: | 1275047458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPANELLI | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | GARRIEVNA | ||||||||
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| Credential: | RN, BSN, IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2645 STOWELL CIR | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968183805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199220468 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 640 ULUKAHIKI ST | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967344454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082635500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2017 | ||||||||
| LastUpdateDate: | 11/26/2017 | ||||||||
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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 | 163WL0100X | L-110119 | VA | N | Nursing Service Providers | Registered Nurse | Lactation Consultant | 163W00000X | 83189 | HI | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | NA | 01 | TRI-CARE | OTHER |