Individual
MS. MIRANDA LAREE BOAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
553 WAINEE ST, LAHAINA, HI 96761-1109
(360) 977-1661
Mailing address
131 IPUKULA WAY, LAHAINA, HI 96761-1779
(360) 977-1661
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/29/2019
Last updated
04/29/2019
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