Healthcare Provider Details

I. General information

NPI: 1144264342
Provider Name (Legal Business Name): KAREN MACISAAC L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5995 KUAKINI HWY
KAILUA KONA HI
96740-2120
US

IV. Provider business mailing address

PO BOX 2878
KAILUA KONA HI
96745-2878
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-4393
  • Fax: 808-329-4393
Mailing address:
  • Phone: 808-329-4393
  • Fax: 808-329-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU 221
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: