Provider Demographics
NPI:1801646153
Name:SCULLY, LAURIE (RN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SCULLY
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 1:75-377 HUALALAI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9724
Mailing Address - Country:US
Mailing Address - Phone:808-938-5153
Mailing Address - Fax:
Practice Address - Street 1:75-377 HUALALAI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9724
Practice Address - Country:US
Practice Address - Phone:808-336-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI37592163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice