Individual
JACQUELYN A WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MAT
Contact information
Practice address
64-5117 WHITE RD, KAMUELA, HI 96743-8239
(808) 344-0429
Mailing address
67-1272 KALEIOHU ST, KAMUELA, HI 96743-8396
(808) 344-0429
(808) 769-4985
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT-2697
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAT-2697
MASSAGE LICENSE
HI
Enumeration date
12/13/2017
Last updated
12/13/2017
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