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General NPI Number Information
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NPI Number | 1093178980
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Entity Type | Individual
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Provider Name | PAULLIE PURDY X LMT
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Gender | Female
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 3-1866 KAUMUALII HWY.
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City | LIHUE
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State | HI
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Zip | 96766
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Country | US
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Telephone | 808-333-3688
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Fax |
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Provider Business Mailing Address
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Address Line | 5370 KAWAIHAU RD.
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City | KAPAA
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State | HI
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Zip | 96746-1209
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Country | US
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Telephone | 808-346-9162
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Fax |
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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 | 10354
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License Number State | HI
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