Provider Demographics
NPI:1902241185
Name:THE DIVINE GUIDE L.L.C.
Entity Type:Organization
Organization Name:THE DIVINE GUIDE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE REGISTER NURSE
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:SETSUKO
Authorized Official - Last Name:KUTAKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-554-7489
Mailing Address - Street 1:47-108 HUI KELU PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4617
Mailing Address - Country:US
Mailing Address - Phone:808-554-7489
Mailing Address - Fax:
Practice Address - Street 1:47-108 HUI KELU PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4617
Practice Address - Country:US
Practice Address - Phone:808-554-7489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 430 RN 15975364SP0808X
HIAPRN 430, RN 15975364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty