Healthcare Provider Details

I. General information

NPI: 1326514464
Provider Name (Legal Business Name): WAILANA SPANGLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 ALA MAKANI ST
KAHULUI HI
96732-3571
US

IV. Provider business mailing address

427 ALA MAKANI ST
KAHULUI HI
96732-3571
US

V. Phone/Fax

Practice location:
  • Phone: 808-204-2893
  • Fax:
Mailing address:
  • Phone: 808-204-2893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-30084
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number666
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: