Provider Demographics
NPI:1457018970
Name:OAHU PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:OAHU PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:CHRYSLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:808-799-2179
Mailing Address - Street 1:153 KUULEI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2719
Mailing Address - Country:US
Mailing Address - Phone:808-799-2179
Mailing Address - Fax:
Practice Address - Street 1:314 ULUNIU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2584
Practice Address - Country:US
Practice Address - Phone:808-799-2179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty