Healthcare Provider Details

I. General information

NPI: 1770920324
Provider Name (Legal Business Name): KATHERINE ANN ENSIGN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MOHOULI ST
HILO HI
96720-4181
US

IV. Provider business mailing address

15-2765 KALA ST
PAHOA HI
96778-9319
US

V. Phone/Fax

Practice location:
  • Phone: 907-854-6982
  • Fax:
Mailing address:
  • Phone: 907-854-6982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: