Provider Demographics
NPI:1043976624
Name:SMITH, MANUEL JR (RN)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:RN
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 323
Mailing Address - Street 2:
Mailing Address - City:MAUNALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96770-0323
Mailing Address - Country:US
Mailing Address - Phone:808-280-4269
Mailing Address - Fax:
Practice Address - Street 1:280 HOME OLU PLACE
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-0408
Practice Address - Country:US
Practice Address - Phone:808-553-3143
Practice Address - Fax:808-553-3140
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-71583163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse