Provider Demographics
NPI:1730743196
Name:DAHL, JOELYN K (LPN)
Entity type:Individual
Prefix:
First Name:JOELYN
Middle Name:K
Last Name:DAHL
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 1:5855 MAHIMAHI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2120
Mailing Address - Country:US
Mailing Address - Phone:808-861-7022
Mailing Address - Fax:
Practice Address - Street 1:5855 MAHIMAHI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2120
Practice Address - Country:US
Practice Address - Phone:808-861-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10802164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse