Provider Demographics
NPI:1053670075
Name:NEIDHAMER, TERESA PAIGE (BA)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:PAIGE
Last Name:NEIDHAMER
Suffix:
Gender:F
Credentials:BA
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 10358
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-5358
Mailing Address - Country:US
Mailing Address - Phone:808-987-1458
Mailing Address - Fax:808-935-4436
Practice Address - Street 1:460 KILAUEA AVE STE 101
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3084
Practice Address - Country:US
Practice Address - Phone:808-935-3481
Practice Address - Fax:808-935-4436
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator