Provider Demographics
NPI:1982577730
Name:WILSON, RHETT
Entity type:Individual
Prefix:
First Name:RHETT
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 ALIILANI PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9034
Mailing Address - Country:US
Mailing Address - Phone:801-814-8273
Mailing Address - Fax:
Practice Address - Street 1:156 ALIILANI PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-9034
Practice Address - Country:US
Practice Address - Phone:801-814-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker