Healthcare Provider Details

I. General information

NPI: 1598003774
Provider Name (Legal Business Name): BRANDON WOHLERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 HOOKELE ST STE 102
KAHULUI HI
96732-3532
US

IV. Provider business mailing address

89 HOOKELE ST STE 102
KAHULUI HI
96732-3532
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-1518
  • Fax: 808-877-3208
Mailing address:
  • Phone: 808-877-1518
  • Fax: 808-877-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number74
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number173
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: