Basic Information
Provider Information
NPI: 1225298250
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AUBE
FirstName: MARIE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 543 WALAKE PL
Address2:  
City: HILO
State: HI
PostalCode: 967203145
CountryCode: US
TelephoneNumber: 8089810325
FaxNumber:  
Practice Location
Address1: 407 ULUNIU ST
Address2: 4TH FLOOR
City: KAILUA
State: HI
PostalCode: 967342519
CountryCode: US
TelephoneNumber: 8082637246
FaxNumber: 8082634604
Other Information
ProviderEnumerationDate: 06/12/2008
LastUpdateDate: 06/12/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X14757HIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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