Provider Demographics
NPI:1306879747
Name:MANNICK, ELIZABETH ELEANOR (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELEANOR
Last Name:MANNICK
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1265 EHU RD
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-7261
Mailing Address - Country:US
Mailing Address - Phone:808-283-6725
Mailing Address - Fax:808-877-6464
Practice Address - Street 1:39 KAMEHAMEHA AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2263
Practice Address - Country:US
Practice Address - Phone:808-877-2424
Practice Address - Fax:808-877-6464
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI138292080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF47941Medicare UPIN