Provider Demographics
NPI:1376981019
Name:NICOLL, MARIA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANN
Last Name:NICOLL
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 1:58-126 MAMAO ST
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9746
Mailing Address - Country:US
Mailing Address - Phone:808-375-3879
Mailing Address - Fax:
Practice Address - Street 1:58-126 MAMAO ST
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-9746
Practice Address - Country:US
Practice Address - Phone:808-375-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-6498225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMAT-6498OtherMASSAGE THERAPIST LICENSE
HIMAE 2071OtherMASSAGE ESTABLISHMENT LICENSE