Healthcare Provider Details

I. General information

NPI: 1114469889
Provider Name (Legal Business Name): KATHRYN T WERNEKE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-408 AKOKI ST SUITE 202
WAIPAHU HI
96797-2733
US

IV. Provider business mailing address

94-1265 LUMIKULA ST # 1B
WAIPAHU HI
96797-4088
US

V. Phone/Fax

Practice location:
  • Phone: 808-676-5584
  • Fax:
Mailing address:
  • Phone: 732-597-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number834
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: