NPIMap

Vickie Marie Fachinelli Portes, RN,C.N.P

Individual provider Active NPI Pediatrics Physician · Keaau, HI

NPI 1871759050 · NPPES record last updated Jul 19, 2022

Key facts

NPI
1871759050
Entity type
Individual (NPI type 1)
Primary specialty
Pediatrics Physician 208000000X
License
APRN-2904 (HI)
Practice address
16-192 Pili Mua St
Keaau, HI 96749-8134
Phone
(808) 333-3600
NPI assigned
Aug 6, 2008
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Certified Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
APRN-2904HIMDPediatrics Physician
R1399752MNMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
West Hawaii Community Health Center, Inc. Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X R1399752 MN
Pediatrics Physician 208000000X APRN-2904 HI Yes

Addresses

Primary practice location

16-192 Pili Mua St
Keaau, HI 96749-8134

Mailing address

75-5751 Kuakini Hwy Ste 203
Kailua Kona, HI 96740-1753
Phone (808) 333-3600

Other practice location 1

1230 E Main St
Mankato, MN 56001-5066
Phone (507) 625-1811 ext. 2139

Other practice location 2

1178 Kinoole St., Bldg B
Hilo, HI 96720
Phone (808) 333-3600

Other providers in Keaau, HI

All providers in Keaau, HI · Pediatrics Physician in Hawaii

Sources for this page

Verify at the official NPI Registry.