Provider Demographics
NPI:1538304985
Name:BROWN, MARY J (RN, LMT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11288
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-6288
Mailing Address - Country:US
Mailing Address - Phone:808-961-6261
Mailing Address - Fax:808-961-6261
Practice Address - Street 1:53 PUUKO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1832
Practice Address - Country:US
Practice Address - Phone:808-961-6261
Practice Address - Fax:808-961-6261
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN 48086163W00000X
CA280777163W00000X
HIMAT 5987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse