Provider Demographics
NPI:1407032261
Name:MAYFIELD, AGNES GALICIA (RN)
Entity Type:Individual
Prefix:MS
First Name:AGNES
Middle Name:GALICIA
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:AGNES
Other - Middle Name:CARLOS
Other - Last Name:GALICIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:95-1039 AAHU ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-6519
Mailing Address - Country:US
Mailing Address - Phone:808-626-5641
Mailing Address - Fax:
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-471-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-47060163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management