Provider Demographics
NPI:1881823888
Name:VINCENT, DIANE JEAN
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:JEAN
Last Name:VINCENT
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 390285
Mailing Address - Street 2:
Mailing Address - City:KEAUHOU
Mailing Address - State:HI
Mailing Address - Zip Code:96739-0285
Mailing Address - Country:US
Mailing Address - Phone:808-854-7306
Mailing Address - Fax:
Practice Address - Street 1:75-166 KALANI ST
Practice Address - Street 2:203
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1857
Practice Address - Country:US
Practice Address - Phone:808-329-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11338225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist