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General NPI Number Information
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NPI Number | 1932506797
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Entity Type | Individual
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Provider Name | NORMAN MICHAEL TRUDELL MLT
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Gender | Male
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 1111 PIIKOI ST APT 22A
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City | HONOLULU
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State | HI
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Zip | 96814-1838
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Country | US
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Telephone | 918-290-9675
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 PIIKOI ST APT 22A
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City | HONOLULU
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State | HI
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Zip | 96814-1838
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Country | US
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Telephone | 918-290-9675
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 5301
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License Number State | HI
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