Provider Demographics
NPI:1558870600
Name:KEOLANUI, MALIA LEWIS (APRN)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:LEWIS
Last Name:KEOLANUI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MALIA
Other - Middle Name:
Other - Last Name:VANNATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27-2470 KAHALA PL
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-640-3466
Mailing Address - Fax:808-365-5811
Practice Address - Street 1:GASTROENTEROLOGY ASSOS. 134 PUUHONU PL PL
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-329-0111
Practice Address - Fax:808-365-5811
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2326363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health