Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY1461 | HI |
Y | 103T00000X | Psychologist | PSY1461 | HI |
NPI | 1013101880 |
---|---|
Provider Name | Dr. Judea Leigh Mcanesby |
First Address | Honokaa, HI 96727-6902 |
Second Address | Honokaa, HI 96727-6902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 30/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY-1461 | STATE LICENSE (01) | HI |