Provider Demographics
NPI:1992912927
Name:JONES, SUSANNE NADINE (LMT)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:NADINE
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 HALL ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-6348
Mailing Address - Country:US
Mailing Address - Phone:808-351-9091
Mailing Address - Fax:
Practice Address - Street 1:407 ULUNIU ST STE 204
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2536
Practice Address - Country:US
Practice Address - Phone:808-266-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI9742OtherLICENSED MASSAGE THERAPIS