Healthcare Provider Details

I. General information

NPI: 1134371685
Provider Name (Legal Business Name): MR. KANOA MERIWETHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HINANO ST
HILO HI
96720-4427
US

IV. Provider business mailing address

PO BOX 741
MOUNTAIN VIEW HI
96771-0741
US

V. Phone/Fax

Practice location:
  • Phone: 808-589-1829
  • Fax: 808-589-2610
Mailing address:
  • Phone: 808-782-1603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: