Provider Demographics
NPI:1962926832
Name:KORU HEALTH AND BEAUTY, LLC
Entity type:Organization
Organization Name:KORU HEALTH AND BEAUTY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-339-3595
Mailing Address - Street 1:64-1035 MAMALAHOA HWY STE J
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8440
Mailing Address - Country:US
Mailing Address - Phone:808-323-2608
Mailing Address - Fax:
Practice Address - Street 1:64-1035 MAMALAHOA HWY STE J
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8440
Practice Address - Country:US
Practice Address - Phone:808-323-2608
Practice Address - Fax:808-885-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
HI1841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID