Provider Demographics
NPI:1396996799
Name:GILLETTE, KRISTIN (M - ED)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:M - ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1841 FORT WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1909
Mailing Address - Country:US
Mailing Address - Phone:808-681-3500
Mailing Address - Fax:808-681-1486
Practice Address - Street 1:333 DAIRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2487
Practice Address - Country:US
Practice Address - Phone:808-877-6888
Practice Address - Fax:808-877-6860
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator