Provider Demographics
NPI:1346804713
Name:GARBO, MIRIAM CAPUS
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:CAPUS
Last Name:GARBO
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 1:1036 NOELANI STREET
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782
Mailing Address - Country:US
Mailing Address - Phone:808-778-5631
Mailing Address - Fax:
Practice Address - Street 1:1265 ALA KULA PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1347
Practice Address - Country:US
Practice Address - Phone:808-831-7866
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
HI56382163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool