1184765281 NPI number — MRS. FABIENNE MARIE WADE PT

Table of content: MRS. FABIENNE MARIE WADE PT (NPI 1184765281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184765281 NPI number — MRS. FABIENNE MARIE WADE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WADE
Provider First Name:
FABIENNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184765281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59-791 ALAPIO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALEIWA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96712-9514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-638-5087
Provider Business Mailing Address Fax Number:
808-535-5556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
932 WARD AVE 6TH FLOOR SUITE 600
Provider Second Line Business Practice Location Address:
MANAKAI O MALAMA
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-535-5555
Provider Business Practice Location Address Fax Number:
808-535-5556
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 603 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00H0028103 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 025244 . This is a "ALOHA CARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 142261 . This is a "DEPT.OF LABOR WASH WC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 142261 . This is a "DEPT.OF LABOR WASH. WC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 025244 . This is a "ALOHA CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02524418 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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