Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | 20-139664 | |
Y | 106S00000X | Behavior Technician | 20-139664 | HI |
NPI | 1003412107 |
---|---|
Provider Name | Angela Michelle Dudoit |
First Address | Waianae, HI 96792-2175 |
Second Address | Waianae, HI 96792-2175 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2020 |
Last Update Date | 05/01/2021 |