Provider Demographics
NPI:1861388431
Name:POMAIKAI WOUND CARE LLC
Entity type:Organization
Organization Name:POMAIKAI WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN COLLIS
Authorized Official - Middle Name:VISIT
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-523-6615
Mailing Address - Street 1:2008 INTERBAY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6799
Mailing Address - Country:US
Mailing Address - Phone:808-621-5042
Mailing Address - Fax:
Practice Address - Street 1:916 KILANI AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2102
Practice Address - Country:US
Practice Address - Phone:808-621-5042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty