Provider Demographics
NPI:1679130116
Name:HAO, TRACY ANN KAPUA
Entity Type:Individual
Prefix:
First Name:TRACY ANN
Middle Name:KAPUA
Last Name:HAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0321
Mailing Address - Country:US
Mailing Address - Phone:808-658-0267
Mailing Address - Fax:
Practice Address - Street 1:2140 FARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOOLEHUA
Practice Address - State:HI
Practice Address - Zip Code:96729
Practice Address - Country:US
Practice Address - Phone:808-567-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12067164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse