Provider Demographics
NPI:1992695738
Name:NELSON, MINKA LEE
Entity type:Individual
Prefix:MISS
First Name:MINKA
Middle Name:LEE
Last Name:NELSON
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 1:8900 KAMEHAMEHA V HWY # 450
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-6007
Mailing Address - Country:US
Mailing Address - Phone:831-252-0928
Mailing Address - Fax:
Practice Address - Street 1:7253 KAMEHAMEHA V HWY # 450
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-6053
Practice Address - Country:US
Practice Address - Phone:808-774-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-25-421201106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician