1528222825 NPI number — MS. MAUREEN ELIZABETH STIASTNY LMT,LAC,MACOM

Table of content: MS. MAUREEN ELIZABETH STIASTNY LMT,LAC,MACOM (NPI 1528222825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528222825 NPI number — MS. MAUREEN ELIZABETH STIASTNY LMT,LAC,MACOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STIASTNY
Provider First Name:
MAUREEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT,LAC,MACOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STIASTNY
Provider Other First Name:
MAURGANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT,LAC,MACOM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528222825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104A IKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAKAWAO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96768-9716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-579-8810
Provider Business Mailing Address Fax Number:
808-579-8290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104A IKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAKAWAO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96768-9716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-579-8810
Provider Business Practice Location Address Fax Number:
808-579-8290
Provider Enumeration Date:
07/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  ACU488 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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