Individual
MICKI N LY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
89 HOOKELE ST, SUITE 101, KAHULUI, HI 96732-3513
(808) 877-6526
(808) 871-6701
Mailing address
PO BOX 3010, KAHULUI, HI 96733-3010
(808) 877-6526
(808) 871-6701
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
MD 12031
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508161
—
HI
Enumeration date
05/08/2006
Last updated
07/08/2007
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