Provider Demographics
NPI:1578886529
Name:AGENTEN, RICHARD (RN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:AGENTEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 KINOOLE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7206
Mailing Address - Country:US
Mailing Address - Phone:808-934-3246
Mailing Address - Fax:808-961-4909
Practice Address - Street 1:1178 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7206
Practice Address - Country:US
Practice Address - Phone:808-934-3246
Practice Address - Fax:808-961-4909
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI49135163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator