Provider Demographics
NPI:1760684054
Name:WIND, LYNN
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:WIND
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:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-0300
Mailing Address - Country:US
Mailing Address - Phone:808-323-3800
Mailing Address - Fax:808-323-3760
Practice Address - Street 1:81-6587 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8133
Practice Address - Country:US
Practice Address - Phone:808-322-9394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 2228225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist