Provider Demographics
NPI:1528314267
Name:VOGELGESANG, ELLARENE KUULIEALOHA
Entity type:Individual
Prefix:MRS
First Name:ELLARENE
Middle Name:KUULIEALOHA
Last Name:VOGELGESANG
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:PO BOX 4386
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-4386
Mailing Address - Country:US
Mailing Address - Phone:808-315-7710
Mailing Address - Fax:
Practice Address - Street 1:74-5620 PALANI RD STE 100
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3640
Practice Address - Country:US
Practice Address - Phone:808-331-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMATT 3913225700000X
HIMATT3913225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist