Provider Demographics
NPI:1265635387
Name:ROGERS, LYNELL U'ILANI (RN, CMC)
Entity Type:Individual
Prefix:
First Name:LYNELL
Middle Name:U'ILANI
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-781 OAMA PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2417
Mailing Address - Country:US
Mailing Address - Phone:808-689-8202
Mailing Address - Fax:808-689-3533
Practice Address - Street 1:91-781 OAMA PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2417
Practice Address - Country:US
Practice Address - Phone:808-689-8202
Practice Address - Fax:808-689-3533
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI39919163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse