Makana O Ka Ola Health and Wellness Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

119306444801 Issued in HI

Legal business name

MAKANA O KA OLA HEALTH AND WELLNESS CLINIC

Practice address

1935 Main St
Suite 102
Wailuku, HI 96793-1784

Phone

(360) 560-3801

NPI assigned

Oct 19, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacey Lyn Prusky, APRN FNP

Title

Officer

Phone

(360) 560-3801

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Elaine Bullock, NP

  • Family Nurse Practitioner
  • Kahului, HI
  • NPI 1609262278
  NPD (past)
• Mishna Orion, PA-C

  • Physician Assistant
  • Wailuku, HI
  • NPI 1558436535
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1750832259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1935 MAIN ST",
            "address_2": "SUITE 102",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931784",
            "telephone_number": "360-560-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 MAIN ST",
            "address_2": "SUITE 102",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931784",
            "telephone_number": "360-560-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKANA O KA OLA HEALTH AND WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "PRUSKY",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "360-560-3801",
        "authorized_official_credential": "APRN FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "HI",
            "license": "119306444801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Troy H. Maetani, MD
• Deborah Maghen, L.AC.
• Samuel Magnotto, RN
• Maureen C. Maguire, MD
• Megan Makahanaloa-Antunez
• Tigist Nigatu Mammo, MD
• Mana Recovery LLC
• Mana Recovery LLC
• Mana Sober Living
• Shane Manago

• Primary Care Clinic/Center in Wailuku, HI
• Providers in Wailuku, HI by specialty
• Primary Care Clinic/Center in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.