Individual
TIFANEE A SMART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16-565 KEAAU PAHOA RD, KEAAU, HI 96749-8113
(808) 313-4862
Mailing address
12-243 W POHAKUPELE LOOP, PAHOA, HI 96778-7863
(808) 825-0616
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB527323
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20315536
—
HI
Enumeration date
10/20/2022
Last updated
10/20/2022
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