Provider Demographics
NPI:1376678565
Name:LOHRENGEL-WEST, MAXI L (PA)
Entity Type:Individual
Prefix:
First Name:MAXI
Middle Name:L
Last Name:LOHRENGEL-WEST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WAILEA GATEWAY PL STE A-203
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6525
Mailing Address - Country:US
Mailing Address - Phone:808-879-1859
Mailing Address - Fax:
Practice Address - Street 1:34 WAILEA GATEWAY PL STE A-203
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6525
Practice Address - Country:US
Practice Address - Phone:808-879-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56372363A00000X
HIAMD-512363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8359473Medicaid
WA8359473Medicaid
WAGAB14636Medicare PIN