Provider Demographics
NPI:1740527860
Name:PRICE, OCTAVIA (CNA)
Entity type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 E KAWILI ST
Mailing Address - Street 2:UNIT 11
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5062
Mailing Address - Country:US
Mailing Address - Phone:808-292-8707
Mailing Address - Fax:
Practice Address - Street 1:34 E KAWILI ST
Practice Address - Street 2:UNIT 11
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5062
Practice Address - Country:US
Practice Address - Phone:808-292-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health