Provider Demographics
NPI:1053780163
Name:JOHNALYN RODRIGUES NOSAKA
Entity type:Organization
Organization Name:JOHNALYN RODRIGUES NOSAKA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNALYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:RODRIGUES NOSAKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:808-960-4163
Mailing Address - Street 1:1084 MILILANI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4351
Mailing Address - Country:US
Mailing Address - Phone:808-960-4163
Mailing Address - Fax:
Practice Address - Street 1:1084 MILILANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4351
Practice Address - Country:US
Practice Address - Phone:808-960-4163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health