Provider Demographics
NPI:1558683474
Name:DEFRIES, DAVELYNN KUULEINANI (RDMS, RVT, BS)
Entity Type:Individual
Prefix:MS
First Name:DAVELYNN
Middle Name:KUULEINANI
Last Name:DEFRIES
Suffix:
Gender:F
Credentials:RDMS, RVT, BS
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 179353
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-8353
Mailing Address - Country:US
Mailing Address - Phone:808-294-8970
Mailing Address - Fax:
Practice Address - Street 1:98-500 KOAUKA LOOP APT 7F
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4590
Practice Address - Country:US
Practice Address - Phone:808-294-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty