Basic Information
| Provider Information | |||||||||
| NPI: | 1972154425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VINCENT | ||||||||
| FirstName: | ANGELIQUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4510 SALT LAKE BLVD STE C4 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968183171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538819945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4510 SALT LAKE BLVD STE C4 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968183171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084861804 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2019 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y | 3747A0650X | N | Nursing Service Related Providers | Technician | Attendant Care Provider |
No ID Information.