Provider Demographics
NPI:1487278354
Name:TRIPP, ADELE KAHEALANI
Entity type:Individual
Prefix:
First Name:ADELE
Middle Name:KAHEALANI
Last Name:TRIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785-0532
Mailing Address - Country:US
Mailing Address - Phone:808-989-5168
Mailing Address - Fax:
Practice Address - Street 1:11-3755 EIGHT ST
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:HI
Practice Address - Zip Code:96785
Practice Address - Country:US
Practice Address - Phone:808-985-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider