Provider Demographics
NPI:1801213178
Name:OKANO, STACEY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:OKANO
Suffix:
Gender:F
Credentials:LPN
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 7014
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-8937
Mailing Address - Country:US
Mailing Address - Phone:808-982-7828
Mailing Address - Fax:808-982-7822
Practice Address - Street 1:16-1397 OLE POHAKU 35TH PLACE
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749
Practice Address - Country:US
Practice Address - Phone:808-982-7828
Practice Address - Fax:808-982-7822
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1525-C376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator