Provider Demographics
NPI:1396257960
Name:RUSSEL, ROCHELLE MAILE
Entity type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:MAILE
Last Name:RUSSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-020 KAMEHAMEHA HWY
Mailing Address - Street 2:#2019
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5717
Mailing Address - Country:US
Mailing Address - Phone:808-674-9998
Mailing Address - Fax:
Practice Address - Street 1:338 KAMOKILA BLVD
Practice Address - Street 2:#201
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2055
Practice Address - Country:US
Practice Address - Phone:808-674-9998
Practice Address - Fax:808-674-9877
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14745225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist