Provider Demographics
NPI:1568483873
Name:HOLLISTER, FRANK (PAC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:HOLLISTER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793
Mailing Address - Country:US
Mailing Address - Phone:808-242-6464
Mailing Address - Fax:808-242-4209
Practice Address - Street 1:2180 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1666
Practice Address - Country:US
Practice Address - Phone:808-242-6464
Practice Address - Fax:808-242-4209
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD2363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI232405OtherHMSA - 65CP
HI55828103Medicaid
HI232405Medicaid
HI99017685996793B098OtherTRICARE - CHAMPUS
HIP31097Medicare UPIN
HIH53410Medicare PIN
HI99017685996793B098OtherTRICARE - CHAMPUS