Basic Information
| Provider Information | |||||||||
| NPI: | 1124337415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHRIVER | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1665 WAILUKU DR | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967201223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096794668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1333 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967201202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089616644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2010 | ||||||||
| LastUpdateDate: | 10/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-34481 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251G0304X | PT-3282 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.