Healthcare Provider Details

I. General information

NPI: 1740292093
Provider Name (Legal Business Name): AMY TOUSMAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 ULUNIU ST APT B
KAILUA HI
96734-2550
US

IV. Provider business mailing address

PO BOX 1408
KAILUA HI
96734-1408
US

V. Phone/Fax

Practice location:
  • Phone: 808-398-3813
  • Fax: 808-262-3813
Mailing address:
  • Phone: 808-398-3813
  • Fax: 808-262-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: