Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 3640 | HI |
NPI | 1003255316 |
---|---|
Provider Name | Nellie Fokumlah |
First Address | Mililani, HI 96789-2985 |
Second Address | Mililani, HI 96789-2985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 19/06/2013 |