Provider Demographics
NPI:1093391252
Name:WALICKI, STEVE
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:
Last Name:WALICKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LAIMANA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2517
Mailing Address - Country:US
Mailing Address - Phone:808-888-9555
Mailing Address - Fax:
Practice Address - Street 1:239 ULULANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7814
Practice Address - Country:US
Practice Address - Phone:808-888-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171WV0202XOther Service ProvidersContractorVehicle Modifications
No374700000XNursing Service Related ProvidersTechnician