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Individual

MARIA ANN NICOLL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
58-126 MAMAO ST, HALEIWA, HI 96712-9746
(808) 375-3879
Mailing address
58-126 MAMAO ST, HALEIWA, HI 96712-9746
(808) 375-3879

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT-6498
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MAE 2071
MASSAGE ESTABLISHMENT LICENSE
HI
01
MAT-6498
MASSAGE THERAPIST LICENSE
HI
Enumeration date
06/04/2013
Last updated
06/04/2013
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