Provider Demographics
NPI:1447623772
Name:BLAKE, LAHELAHO'OPOMAIKA'I (APRN-RX)
Entity type:Individual
Prefix:
First Name:LAHELAHO'OPOMAIKA'I
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-005 KAWA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3812
Mailing Address - Country:US
Mailing Address - Phone:808-247-9616
Mailing Address - Fax:808-278-5647
Practice Address - Street 1:46-005 KAWA ST STE 203
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3812
Practice Address - Country:US
Practice Address - Phone:808-247-9616
Practice Address - Fax:808-278-5647
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily