Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MAT8322 | HI |
NPI | 1013929827 |
---|---|
Provider Name | Monica Stevens |
First Address | Wailuku, HI 96793-1666 |
Second Address | Wailuku, HI 96793-1666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/07/2007 |