Healthcare Provider Details

I. General information

NPI: 1396903977
Provider Name (Legal Business Name): PAUAHI LYNEAN MCDONALD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92-1427 CORAL PKWY
OCEAN VIEW HI
96737
US

IV. Provider business mailing address

PO BOX 6271
OCEAN VIEW HI
96737-6271
US

V. Phone/Fax

Practice location:
  • Phone: 808-491-3770
  • Fax:
Mailing address:
  • Phone: 808-491-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10237
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: