Provider Demographics
NPI:1104594225
Name:SALLY MCTIGUE APRN-RX LTD
Entity type:Organization
Organization Name:SALLY MCTIGUE APRN-RX LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCTIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-RX
Authorized Official - Phone:808-699-1814
Mailing Address - Street 1:PO BOX 2154
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-8154
Mailing Address - Country:US
Mailing Address - Phone:808-818-7031
Mailing Address - Fax:808-207-3507
Practice Address - Street 1:1314 S KING ST STE 723
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1942
Practice Address - Country:US
Practice Address - Phone:808-818-7031
Practice Address - Fax:808-207-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAPRN2852OtherAPRN LICENSE
1891320800OtherNPI
1891320800OtherNPI