Provider Demographics
NPI:1154937589
Name:PERCY, MYKAELA (LPN)
Entity type:Individual
Prefix:
First Name:MYKAELA
Middle Name:
Last Name:PERCY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 KOMOHANA CT UNIT 201
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-5446
Mailing Address - Country:US
Mailing Address - Phone:573-855-6950
Mailing Address - Fax:
Practice Address - Street 1:66-505 HALEIWA RD
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1599
Practice Address - Country:US
Practice Address - Phone:808-637-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19896164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse