Provider Demographics
NPI:1629806302
Name:JOHANSEN, FRANCINE BETH
Entity type:Individual
Prefix:
First Name:FRANCINE
Middle Name:BETH
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WAOKELE PL
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8756
Mailing Address - Country:US
Mailing Address - Phone:808-357-4828
Mailing Address - Fax:
Practice Address - Street 1:17 WAOKELE PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8756
Practice Address - Country:US
Practice Address - Phone:808-357-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-3803225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist