Basic Information
| Provider Information | |||||||||
| NPI: | 1841896024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACHACOSO | ||||||||
| FirstName: | JOHN PAUL | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 92-1545 ALIINUI DR UNIT 3D | ||||||||
| Address2: | |||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104498028 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6905 HARRIS AVE, MCBH | ||||||||
| Address2: | |||||||||
| City: | FPO | ||||||||
| State: | AP | ||||||||
| PostalCode: | 967349673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084731880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2020 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 99325 | HI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.