Provider Demographics
NPI:1841661915
Name:MATHER, CAROLYN DONOHOE (MAS, RD,LD, IBCLC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DONOHOE
Last Name:MATHER
Suffix:
Gender:F
Credentials:MAS, RD,LD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649A LEILEHUA LN
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-1627
Mailing Address - Country:US
Mailing Address - Phone:808-888-9949
Mailing Address - Fax:
Practice Address - Street 1:1649A LEILEHUA LN
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-1627
Practice Address - Country:US
Practice Address - Phone:808-888-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI59-LD133V00000X
HI174H00000X
HI10986724174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN