Basic Information
| Provider Information | |||||||||
| NPI: | 1033886312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOYER | ||||||||
| FirstName: | NINA | ||||||||
| MiddleName: | CORAL | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3083 AKAHI ST | ||||||||
| Address2: | LIHUE | ||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082455841 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3083 AKAHI ST | ||||||||
| Address2: | |||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967661102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082455841 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2021 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 20146713 | HI | Y |
No ID Information.