Provider Demographics
NPI:1760818462
Name:MABRY, BROOK DAWNYEL (LMT 13362)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:DAWNYEL
Last Name:MABRY
Suffix:
Gender:F
Credentials:LMT 13362
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 PIIKOI ST
Mailing Address - Street 2:APT 204
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-4081
Mailing Address - Country:US
Mailing Address - Phone:903-220-2434
Mailing Address - Fax:
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:1210
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-596-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13362173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI13362OtherLMT