Basic Information
| Provider Information | |||||||||
| NPI: | 1558870600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANNATTA | ||||||||
| FirstName: | MALIA | ||||||||
| MiddleName: | LEWIS | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1628 | ||||||||
| Address2: | |||||||||
| City: | KAMUELA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967431628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086403466 | ||||||||
| FaxNumber: | 8083655811 | ||||||||
| Practice Location | |||||||||
| Address1: | 75-184 HULALALAI RD | ||||||||
| Address2: | 302 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083290111 | ||||||||
| FaxNumber: | 8083655811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 363LA2200X | 2326 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.