Individual
IAN MATTHEW WORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
82-6065 MAMALAHOA HWY, APT A203, CAPTAIN COOK, HI 96704-0564
(808) 266-5378
Mailing address
PO BOX 564, CAPTAIN COOK, HI 96704-0564
(503) 703-5383
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
16-141
HI
Other
Enumeration date
05/06/2016
Last updated
05/14/2016
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