Healthcare Provider Details

I. General information

NPI: 1679644777
Provider Name (Legal Business Name): LORI A CAMPBELL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 BOX 5655 16-1874 36TH AVE
KEAAU HI
96749-9404
US

IV. Provider business mailing address

HC 1 BOX 5655 16-1874 36TH AVE.
KEAAU HI
96749-9404
US

V. Phone/Fax

Practice location:
  • Phone: 808-982-5846
  • Fax:
Mailing address:
  • Phone: 808-982-5846
  • Fax: 808-982-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number484
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: