Provider Information for 1912375593
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SHEALIN JOHNSON
Sex: Female
NPI: 1912375593
Last Updated: 2015-09-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1912375593 | ||||||||
| Enumeration Date | 2015-09-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 112 HAOKEA DR KAILUA, HI 96734-3215 United States Phone: 808-321-2953 | Fax: | ||||||||
| Primary Practice Address | 45-021 LIKEKE PL KANEOHE, HI 96744-2426 United States Phone: 808-235-1377 | Fax: | ||||||||
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