Individual
JOHANNA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
399 E KAWILI ST STE 202, HILO, HI 96720-5075
(808) 315-1432
Mailing address
PO BOX 6111, KAMUELA, HI 96743-6111
(808) 315-1432
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MHC-427
HI
Other
Enumeration date
07/16/2013
Last updated
03/25/2020
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