Basic Information
| Provider Information | |||||||||
| NPI: | 1871759050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FACHINELLI PORTES | ||||||||
| FirstName: | VICKIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RN,C.N.P | ||||||||
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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: | 16-192 PILI MUA ST | ||||||||
| Address2: | |||||||||
| City: | KEAAU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967498134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083333600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2008 | ||||||||
| 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 | 363LP0200X | R1399752 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 208000000X | APRN-2904 | HI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.