Provider Demographics
NPI:1477890820
Name:QUEYREL, NICOLE B (MAT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:QUEYREL
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SAINT LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1920
Mailing Address - Country:US
Mailing Address - Phone:808-224-9700
Mailing Address - Fax:
Practice Address - Street 1:2875 S KING ST
Practice Address - Street 2:SUITE #205
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3508
Practice Address - Country:US
Practice Address - Phone:808-942-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 7653171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor