Provider Demographics
NPI:1134402779
Name:GREEN, MAILE L (ND, LAC, RN)
Entity type:Individual
Prefix:DR
First Name:MAILE
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:ND, LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-547 UKEE ST STE 305
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4451
Mailing Address - Country:US
Mailing Address - Phone:808-464-2377
Mailing Address - Fax:
Practice Address - Street 1:94-547 UKEE ST STE 305
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4451
Practice Address - Country:US
Practice Address - Phone:808-464-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI78012163W00000X
HI1166171100000X
HI215175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist