Provider Demographics
NPI:1861520306
Name:FLANNERY, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-0503
Mailing Address - Country:US
Mailing Address - Phone:808-217-1710
Mailing Address - Fax:808-322-4817
Practice Address - Street 1:79-1020 HAUKAPILA ST
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7922
Practice Address - Country:US
Practice Address - Phone:808-322-4818
Practice Address - Fax:808-322-4817
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN - 29783163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI539372-18Medicaid