Provider Demographics
NPI:1619191426
Name:STATE OF HAWAII, DEPARTMENT OF HEALTH, PUBLIC HEALTH NURSING
Entity Type:Organization
Organization Name:STATE OF HAWAII, DEPARTMENT OF HEALTH, PUBLIC HEALTH NURSING
Other - Org Name:PUBLIC HEALTH NURSING
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF, PUBLIC HEALTH NURSING BRANCH
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:OTA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-586-4620
Mailing Address - Street 1:1250 PUNCHBOWL ST RM 210
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2416
Mailing Address - Country:US
Mailing Address - Phone:808-586-4620
Mailing Address - Fax:808-586-8165
Practice Address - Street 1:1250 PUNCHBOWL ST RM 210
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2416
Practice Address - Country:US
Practice Address - Phone:808-586-4620
Practice Address - Fax:808-586-8165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI522525Medicaid