Healthcare Provider Details

I. General information

NPI: 1457485021
Provider Name (Legal Business Name): TRACEY DAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79-1020 HAUKAPILA ST
KEALAKEKUA HI
96750-7922
US

IV. Provider business mailing address

PO BOX 664
KEALAKEKUA HI
96750-0664
US

V. Phone/Fax

Practice location:
  • Phone: 808-327-9530
  • Fax: 808-327-9534
Mailing address:
  • Phone: 808-322-4818
  • Fax: 808-322-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: