| Pukalani Family Practice, Llc | |
|
81 Makawao Ave Ste 100 Makawao HI 96768-8859 | |
| (808) 573-8900 | |
| (808) 573-7505 |
| Full Name | Pukalani Family Practice, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 81 Makawao Ave Ste 100, Makawao, Hawaii |
| Authorized Official Name and Position | Dayaji Green (OFFICE MANAGER) |
| Authorized Official Contact | 8085738900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pukalani Family Practice, Llc 81 Makawao Ave Ste 100 Makawao HI 96768-8859 Ph: (808) 573-8900 | Pukalani Family Practice, Llc 81 Makawao Ave Ste 100 Makawao HI 96768-8859 Ph: (808) 573-8900 |
| NPI Number | 1063009207 |
|---|---|
| Provider Enumeration Date | 12/22/2020 |
| Last Update Date | 12/22/2020 |
| Medicare PECOS PAC ID | 2567877178 |
|---|---|
| Medicare Enrollment ID | O20210211003491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063009207 | NPI | - | NPPES |
| Provider Name | Robert P Mastroianni |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023107844 PECOS PAC ID: 3779579768 Enrollment ID: I20040423001062 |
| Provider Name | Ann Craddock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982823373 PECOS PAC ID: 4587717111 Enrollment ID: I20090729000944 |
| Provider Name | Liat Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245781368 PECOS PAC ID: 4587946082 Enrollment ID: I20170118000680 |
| Provider Name | Kelsey R Ennila |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1518098144 PECOS PAC ID: 6305943523 Enrollment ID: I20211110002724 |
| Provider Name | Madison C Furlong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861155350 PECOS PAC ID: 0648669598 Enrollment ID: I20211115001185 |
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