Individual
BONNY ANNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
167 AIPUNI ST, HILO, HI 96720-1803
(808) 959-5855
Mailing address
1786 KINOOLE ST, HILO, HI 96720-5245
(808) 959-5855
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
10/07/2021
Last updated
10/07/2021
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