Provider Demographics
NPI:1538949813
Name:DAVIS, JULIE-ELLEN KANOE KAHOOHANOHANO (LPN)
Entity type:Individual
Prefix:
First Name:JULIE-ELLEN
Middle Name:KANOE KAHOOHANOHANO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MOLOKAI AKAU ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2628
Mailing Address - Country:US
Mailing Address - Phone:808-276-2139
Mailing Address - Fax:
Practice Address - Street 1:366 MOLOKAI AKAU ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2628
Practice Address - Country:US
Practice Address - Phone:808-276-2139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14827164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse