Healthcare Provider Details

I. General information

NPI: 1205083003
Provider Name (Legal Business Name): ANNEKA BOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNEKA KECK

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-170 HUALALAI RD
KAILUA KONA HI
96740-1779
US

IV. Provider business mailing address

615 PIIKOI ST # 203
HONOLULU HI
96814-3116
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-6395
  • Fax: 808-329-1461
Mailing address:
  • Phone: 808-589-1829
  • Fax: 808-589-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: