Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 15985 | HI |
NPI | 1013517895 |
---|---|
Provider Name | Tammy N Fondren |
First Address | Kapolei, HI 96707-2055 |
Second Address | Kapolei, HI 96707-2055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2020 |
Last Update Date | 24/11/2020 |