Provider Demographics
NPI:1205325016
Name:LOONEY, MICHAEL (LPN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LOONEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HOOHANA ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2476
Mailing Address - Country:US
Mailing Address - Phone:808-873-6129
Mailing Address - Fax:808-871-2106
Practice Address - Street 1:203 HOOHANA ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2476
Practice Address - Country:US
Practice Address - Phone:808-873-6129
Practice Address - Fax:808-871-2106
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILPN-17533164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse