Healthcare Provider Details

I. General information

NPI: 1760818462
Provider Name (Legal Business Name): BROOK DAWNYEL MABRY LMT 13362
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI ST 1210
HONOLULU HI
96814-3116
US

IV. Provider business mailing address

1402 PIIKOI ST APT 204
HONOLULU HI
96822-4081
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-7300
  • Fax:
Mailing address:
  • Phone: 903-220-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number13362
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: