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General NPI Number Information
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NPI Number | 1386059145
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Entity Type | Organization
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Legal Business Name | KRISTEN NELSON
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 59-065 PAUMALU PL
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City | HALEIWA
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State | HI
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Zip | 96712-9751
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Country | US
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Telephone | 808-372-9298
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 286
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City | HALEIWA
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State | HI
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Zip | 96712-0286
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Country | US
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Telephone | 808-372-9298
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Fax |
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Authorized Official
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Title or Position | OWNER/ LICENSED MASSAGE THERAPIST
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Name | KRISTEN NELSON
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Credential |
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Telephone | 808-372-9298
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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 | MAT13264
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License Number State | HI
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