Provider Demographics
NPI:1841830767
Name:EMMEL, REENIE
Entity type:Individual
Prefix:
First Name:REENIE
Middle Name:
Last Name:EMMEL
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 1:1875 KALANIANAOLE AVE APT 411
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4902
Mailing Address - Country:US
Mailing Address - Phone:224-281-2457
Mailing Address - Fax:
Practice Address - Street 1:1875 KALANIANAOLE AVE APT 411
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4902
Practice Address - Country:US
Practice Address - Phone:224-281-2457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI93833163W00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse