Provider Demographics
NPI:1700929056
Name:KEOPUHIWA, JEANELLA (LMT)
Entity type:Individual
Prefix:MS
First Name:JEANELLA
Middle Name:
Last Name:KEOPUHIWA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:JEANELLA
Other - Middle Name:
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785
Mailing Address - Country:US
Mailing Address - Phone:808-967-7439
Mailing Address - Fax:808-967-8518
Practice Address - Street 1:16590 B OLD VOLCANO RD
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749
Practice Address - Country:US
Practice Address - Phone:808-967-7439
Practice Address - Fax:808-967-8518
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist