Provider Demographics
NPI:1952804742
Name:PHELAN, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:PHELAN
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 1:10 S LAELUA PL
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-8111
Mailing Address - Country:US
Mailing Address - Phone:808-443-3943
Mailing Address - Fax:
Practice Address - Street 1:10 S LAELUA PL
Practice Address - Street 2:
Practice Address - City:PAIA
Practice Address - State:HI
Practice Address - Zip Code:96779-8111
Practice Address - Country:US
Practice Address - Phone:808-443-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist