Provider Demographics
NPI:1447893755
Name:BERINOBIS, NICOLE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:BERINOBIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64-197 PUU PULEHU LOOP
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8021
Mailing Address - Country:US
Mailing Address - Phone:808-896-9188
Mailing Address - Fax:
Practice Address - Street 1:65-1235 OPELO RD STE 8
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8454
Practice Address - Country:US
Practice Address - Phone:808-896-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15031225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH01292788OtherDRIVERS LICENSE