Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT-1793 | HI |
NPI | 1891271755 |
---|---|
Provider Name | Nichol Hordal |
First Address | Ewa Beach, HI 96706-3602 |
Second Address | Ewa Beach, HI 96706-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2018 |
Last Update Date | 13/07/2018 |