Provider Demographics
NPI:1881653756
Name:KVENILD, ROBERTA J (CNM)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:J
Last Name:KVENILD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2799
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-2799
Mailing Address - Country:US
Mailing Address - Phone:808-885-9606
Mailing Address - Fax:808-885-9506
Practice Address - Street 1:65-1267 KAWAIHAE RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8406
Practice Address - Country:US
Practice Address - Phone:808-885-9606
Practice Address - Fax:808-885-9506
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI117367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA0240513OtherHMSA NUMBER
HI9884549OtherUHA NUMBER
HI54135100Medicaid
HIP03560Medicare UPIN