Provider Demographics
NPI:1487767836
Name:POLLOCK, ANNE ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5751 KUAKINI HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1753
Mailing Address - Country:US
Mailing Address - Phone:808-333-3600
Mailing Address - Fax:808-961-5167
Practice Address - Street 1:15-2866 PAHOA VILLAGE RD BLDG C
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-7720
Practice Address - Country:US
Practice Address - Phone:808-333-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA102923363LF0000X, 363LW0102X
HI2745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71837OtherWELLMARK UIQC SEIC
IAI11716001OtherMEDICARE WP
IA1487767836OtherMEDICAID UICMS
IA71823OtherWELLMARK UIQC OCTC
IA71836OtherWELLMARK UIQC NL
IA71839OtherWELLMARK LW
IA2209304Medicaid
IAI1421001OtherMEDICARE UI QC
IAI1416001OtherMEDICARE LW
IA39343OtherBCBS PPO NUMBER
IAP00474250OtherRR MEDICARE
IA71838OtherWELLMARK WP
IA067000003Medicare UPIN