Provider Demographics
NPI:1356087076
Name:OKAMOTO, MARY PAIGE (DVM)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PAIGE
Last Name:OKAMOTO
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:PAIGE
Other - Last Name:GANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DVM
Mailing Address - Street 1:701 MILILANI PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9365
Mailing Address - Country:US
Mailing Address - Phone:205-563-3303
Mailing Address - Fax:
Practice Address - Street 1:701 MILILANI PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-9365
Practice Address - Country:US
Practice Address - Phone:205-563-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIVE-906376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker