Individual
MS. SUSAN INA BOHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
69 N CHURCH ST, WAILUKU, HI 96793-1611
(808) 244-1164
Mailing address
PO BOX 790326, PAIA, HI 96779-0326
(808) 572-2115
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MAT 6806
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAT 6806
MASSAGE THERAPIST #
HI
Enumeration date
11/12/2006
Last updated
07/08/2007
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