Provider Demographics
NPI:1306825914
Name:MIYAMOTO, ROBIN LYNNE (LPN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNNE
Last Name:MIYAMOTO
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 1:350 AOLOA ST
Mailing Address - Street 2:A222
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3018
Mailing Address - Country:US
Mailing Address - Phone:808-228-3058
Mailing Address - Fax:
Practice Address - Street 1:350 AOLOA ST
Practice Address - Street 2:A222
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3018
Practice Address - Country:US
Practice Address - Phone:808-228-3058
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILPN-10329164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HILPN-10329OtherNURSING