Basic Information
| Provider Information | |||||||||
| NPI: | 1487767836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLLOCK | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-5751 KUAKINI HWY STE 203 | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083333600 | ||||||||
| FaxNumber: | 8089615167 | ||||||||
| Practice Location | |||||||||
| Address1: | 15-2866 PAHOA VILLAGE RD BLDG C | ||||||||
| Address2: | |||||||||
| City: | PAHOA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967787720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083333600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A102923 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LW0102X | A102923 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363L00000X | 2745 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 71837 | 01 | IA | WELLMARK UIQC SEIC | OTHER | I11716001 | 01 | IA | MEDICARE WP | OTHER | 1487767836 | 01 | IA | MEDICAID UICMS | OTHER | 71823 | 01 | IA | WELLMARK UIQC OCTC | OTHER | 71836 | 01 | IA | WELLMARK UIQC NL | OTHER | 71839 | 01 | IA | WELLMARK LW | OTHER | 2209304 | 05 | IA | MEDICAID | I1421001 | 01 | IA | MEDICARE UI QC | OTHER | I1416001 | 01 | IA | MEDICARE LW | OTHER | 39343 | 01 | IA | BCBS PPO NUMBER | OTHER | P00474250 | 01 | IA | RR MEDICARE | OTHER | 71838 | 01 | IA | WELLMARK WP | OTHER |