Provider Demographics
NPI:1356586614
Name:ROSS, DANA LOUISE (LMT)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:LOUISE
Last Name:ROSS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:LOUISE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 1442
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-1442
Mailing Address - Country:US
Mailing Address - Phone:808-634-5558
Mailing Address - Fax:808-212-1102
Practice Address - Street 1:4440 HOOKUI ROAD
Practice Address - Street 2:#7A
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754
Practice Address - Country:US
Practice Address - Phone:808-634-5558
Practice Address - Fax:808-212-1102
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9121171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor