Basic Information
| Provider Information | |||||||||
| NPI: | 1649671199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NISHIMOTO | ||||||||
| FirstName: | ANNETTE | ||||||||
| MiddleName: | MARIE GUERRIERO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 412 | ||||||||
| Address2: | |||||||||
| City: | KALAHEO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967410412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086390074 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3-3122 KUHIO HWY | ||||||||
| Address2: | SUITE A5 | ||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967661147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082469102 | ||||||||
| FaxNumber: | 8082468609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2014 | ||||||||
| LastUpdateDate: | 09/15/2014 | ||||||||
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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 | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.