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General NPI Number Information
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NPI Number | 1013288653
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Entity Type | Individual
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Provider Name | CHET GLENN LMT
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Gender | Male
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 75-233 NANI KAILUA DR #129
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City | KAILUA KONA
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State | HI
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Zip | 96740-2033
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Country | US
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Telephone | 808-329-1830
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Fax | 808-329-1830
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Provider Business Mailing Address
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Address Line | 75-233 NANI KAILUA DR #129
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City | KAILUA KONA
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State | HI
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Zip | 96740-2033
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Country | US
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Telephone | 808-329-1830
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Fax | 808-329-1830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3332
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License Number State | HI
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