Provider Demographics
NPI:1770147928
Name:ITAMOTO, SOUKSAMLANE (RN)
Entity type:Individual
Prefix:
First Name:SOUKSAMLANE
Middle Name:
Last Name:ITAMOTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-939 AKAHOLO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2203
Mailing Address - Country:US
Mailing Address - Phone:808-358-9540
Mailing Address - Fax:
Practice Address - Street 1:91-980 NORTH RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2746
Practice Address - Country:US
Practice Address - Phone:808-305-3659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI64049163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse