Provider Demographics
NPI:1487213427
Name:VIDINHA, LIZANN
Entity Type:Individual
Prefix:
First Name:LIZANN
Middle Name:
Last Name:VIDINHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 KAWAIHAU RD STE F
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1964
Mailing Address - Country:US
Mailing Address - Phone:808-821-6944
Mailing Address - Fax:808-821-6949
Practice Address - Street 1:4800 KAWAIHAU RD STE F
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1964
Practice Address - Country:US
Practice Address - Phone:808-821-6944
Practice Address - Fax:808-821-6949
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker