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General NPI Number Information
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NPI Number | 1912137035
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Entity Type | Individual
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Provider Name | NALANI TAVIA GRACE PSY.D., CSAC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 1 JARRETT WHITE RD
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City | TRIPLER ARMY MEDICAL CENTER
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State | HI
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Zip | 96859-5001
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Country | US
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Telephone | 808-655-9034
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Fax |
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Provider Business Mailing Address
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Address Line | 1154 AIKOO PL
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City | PEARL CITY
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State | HI
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Zip | 96782-2621
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Country | US
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Telephone | 808-478-1842
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 1127
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License Number State | HI
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