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General NPI Number Information
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NPI Number | 1801015219
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Entity Type | Individual
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Provider Name | MARTHA JEAN MCDANIEL LMT
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 70 CENTRAL AVE SUITE 4
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City | WAILUKU
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State | HI
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Zip | 96793-1701
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Country | US
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Telephone | 808-281-0302
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1098
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City | WAILUKU
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State | HI
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Zip | 96793-1098
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Country | US
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Telephone | 808-281-0302
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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 | MAT5416
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License Number State | HI
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