Provider Demographics
NPI:1972743250
Name:TANIGAWA, NICOLE T (MT)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:T
Last Name:TANIGAWA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 AWA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5809
Mailing Address - Country:US
Mailing Address - Phone:808-981-5000
Mailing Address - Fax:
Practice Address - Street 1:475 AWA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5809
Practice Address - Country:US
Practice Address - Phone:808-981-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3665225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist