Healthcare Provider Details

I. General information

NPI: 1013502863
Provider Name (Legal Business Name): EVA CANNAMELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVA BRIERS

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1272 KAILEOLEA DR
EWA BEACH HI
96706-6274
US

IV. Provider business mailing address

91-1272 KAILEOLEA DR
EWA BEACH HI
96706-6274
US

V. Phone/Fax

Practice location:
  • Phone: 443-994-9563
  • Fax:
Mailing address:
  • Phone: 443-994-9563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5657
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: