Basic Information
| Provider Information | |||||||||
| NPI: | 1841964780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | NELSON | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1881 KAPIOLANI BLVD APT 402 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968263820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085489291 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 203 KAPAA QUARRY PLACE #5002 | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082472973 | ||||||||
| FaxNumber: | 8084273472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2021 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.