Healthcare Provider Details

I. General information

NPI: 1619574480
Provider Name (Legal Business Name): ANN ELIZABETH MEVIS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 BALDWIN AVE
PAIA HI
96779
US

IV. Provider business mailing address

PO BOX 791101
PAIA HI
96779-1101
US

V. Phone/Fax

Practice location:
  • Phone: 808-579-9134
  • Fax:
Mailing address:
  • Phone: 808-283-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-7256
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: