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General NPI Number Information
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NPI Number | 1780702308
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Entity Type | Individual
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Provider Name | NATHANIEL U D YESAN LMT
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 4268 RICE ST STE J
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City | LIHUE
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State | HI
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Zip | 96766-1318
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Country | US
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Telephone | 808-652-2946
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Fax | 808-652-2946
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Provider Business Mailing Address
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Address Line | PO BOX 1894
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City | LIHUE
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State | HI
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Zip | 96766-5894
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Country | US
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Telephone | 808-652-2946
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 6301
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License Number State | HI
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