Active NPI
Nelson Park
- Social Worker
- Pearl City, HI
National Provider Identifier
1295873131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LSW 693
- Practice address
- 860 Fourth St
Pearl City, HI 96782-3312 - Phone
- (808) 453-5950
- Fax
- (808) 453-5966
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LSW 693 | HI | Primary |
Addresses
Primary practice location
860 Fourth St
Pearl City, HI 96782-3312
Mailing address
1700 Lanakila Ave
Honolulu, HI 96817-2115
Phone (808) 832-3823
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LSW 693 | HI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295873131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 LANAKILA AVE",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968172115",
"telephone_number": "808-832-3823",
"fax_number": "808-832-5850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "860 FOURTH ST",
"city": "PEARL CITY",
"state": "HI",
"postal_code": "967823312",
"telephone_number": "808-453-5950",
"fax_number": "808-453-5966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "NELSON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "HI",
"license": "LSW 693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pearl City, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.