Provider Demographics
NPI:1962887315
Name:KILONZO, EUCABETH A (APRN)
Entity type:Individual
Prefix:
First Name:EUCABETH
Middle Name:A
Last Name:KILONZO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EUCABETH
Other - Middle Name:A
Other - Last Name:KILONZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:754 HIBISCUS ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1287
Mailing Address - Country:US
Mailing Address - Phone:808-436-3050
Mailing Address - Fax:
Practice Address - Street 1:WAIANAE COAST COMPREHENSIVE HEALTH CENTER
Practice Address - Street 2:86-260 FARRINGTON HWY
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792
Practice Address - Country:US
Practice Address - Phone:808-697-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962887315OtherNPPES