Provider Demographics
NPI:1821323221
Name:KEALOHA, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:KEALOHA
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 1:95 MAHALANI ST
Mailing Address - Street 2:19A
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2521
Mailing Address - Country:US
Mailing Address - Phone:808-244-7467
Mailing Address - Fax:808-242-5835
Practice Address - Street 1:95 MAHALANI ST
Practice Address - Street 2:19A
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2521
Practice Address - Country:US
Practice Address - Phone:808-244-7467
Practice Address - Fax:808-242-5835
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator