Provider Demographics
NPI:1831752534
Name:YASUDA, MICHELLE ULIT
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ULIT
Last Name:YASUDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-1014 MAKAKILO DR # 37
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1381
Mailing Address - Country:US
Mailing Address - Phone:808-627-5456
Mailing Address - Fax:
Practice Address - Street 1:92-1014 MAKAKILO DR # 37
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1381
Practice Address - Country:US
Practice Address - Phone:808-627-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13591164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse