Healthcare Provider Details

I. General information

NPI: 1720014103
Provider Name (Legal Business Name): DEBORAH K NAMOHALA ATC, EMT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W KAWILI ST
HILO HI
96720-5038
US

IV. Provider business mailing address

155 W KAWILI ST
HILO HI
96720-5038
US

V. Phone/Fax

Practice location:
  • Phone: 808-974-4888
  • Fax: 808-974-4880
Mailing address:
  • Phone: 808-974-4888
  • Fax: 808-974-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: