Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 0119003304 | VA |
NPI | 1144227091 |
---|---|
Provider Name | Ms. Nicole Cardillo |
First Address | Ewa Beach, HI 96706-2049 |
Second Address | Mililani, HI 96789-1192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 11/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ANTHEM BC/BS | 278740 (01) | VA |
C05501 | MEDICARE GROUP PTAN (01) | VA |