Provider Demographics
NPI:1588022768
Name:PUTRINO, RACHEL LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:PUTRINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 NOKE ST
Mailing Address - Street 2:APT 8
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1744
Mailing Address - Country:US
Mailing Address - Phone:608-347-1808
Mailing Address - Fax:
Practice Address - Street 1:45-1144 KAMEHAMEHA HWY
Practice Address - Street 2:#500
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3244
Practice Address - Country:US
Practice Address - Phone:808-247-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant