Provider Information for 1720475312
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DONNA DENNERLEIN
Sex: Female
NPI: 1720475312
Last Updated: 2017-04-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1720475312 | ||||||||||||
| Enumeration Date | 2015-04-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 74-381 KEALAKEHE PKWY SUITE F KAILUA KONA, HI 96740-2705 United States Phone: 209-261-0166 | Fax: | ||||||||||||
| Primary Practice Address | 74-381 KEALAKEHE PKWY SUITE F KAILUA KONA, HI 96740-2705 United States Phone: 209-261-0166 | Fax: | ||||||||||||
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