Healthcare Provider Details

I. General information

NPI: 1679081046
Provider Name (Legal Business Name): LORI PUSATERI L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 HINANO ST
HILO HI
96720-4406
US

IV. Provider business mailing address

PO BOX 426
PAPAIKOU HI
96781-0426
US

V. Phone/Fax

Practice location:
  • Phone: 808-640-7766
  • Fax:
Mailing address:
  • Phone: 808-640-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1184
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: