Provider Demographics
NPI:1801220413
Name:TAYLOR, RENE MAHEALANI
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:MAHEALANI
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:MAHEALANI
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1644 LIHOLIHO ST
Mailing Address - Street 2:APT J
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2901
Mailing Address - Country:US
Mailing Address - Phone:915-342-0200
Mailing Address - Fax:
Practice Address - Street 1:1644 LIHOLIHO ST
Practice Address - Street 2:APT J
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2901
Practice Address - Country:US
Practice Address - Phone:915-342-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17638164W00000X
TX219145164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse