Provider Demographics
NPI:1578788683
Name:CARDWELL, DONNA MARIA (LMT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIA
Last Name:CARDWELL
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 1:76 726C HUALALAI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8932
Mailing Address - Country:US
Mailing Address - Phone:808-640-0669
Mailing Address - Fax:
Practice Address - Street 1:75-5929 ALII DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1323
Practice Address - Country:US
Practice Address - Phone:808-329-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist