Provider Demographics
NPI:1225109499
Name:DANIELS, WIEBKE (MS, LMT)
Entity Type:Individual
Prefix:MRS
First Name:WIEBKE
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MS, LMT
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 626
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-0626
Mailing Address - Country:US
Mailing Address - Phone:808-250-3020
Mailing Address - Fax:808-244-5557
Practice Address - Street 1:3660 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7500
Practice Address - Country:US
Practice Address - Phone:808-250-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-5497174400000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1039824OtherASH PROVIDER