Provider Demographics
NPI:1821765124
Name:FINE, MOLLIE (RN)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:FINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 KIKA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4521
Mailing Address - Country:US
Mailing Address - Phone:808-237-0782
Mailing Address - Fax:
Practice Address - Street 1:1286 KIKA ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4521
Practice Address - Country:US
Practice Address - Phone:808-237-0782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-80888163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health