Provider Demographics
NPI:1639877004
Name:OLAYAN, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:OLAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:COURTNEY
Other - Middle Name:LEE
Other - Last Name:RHOADS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:91-972 OANIANI ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2627
Mailing Address - Country:US
Mailing Address - Phone:808-260-0809
Mailing Address - Fax:
Practice Address - Street 1:785 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2753
Practice Address - Country:US
Practice Address - Phone:808-260-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable