Provider Demographics
NPI:1083117733
Name:MARTYN, CHERIE (LAC)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:MARTYN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 NUUANU AVE APT 12B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2530
Mailing Address - Country:US
Mailing Address - Phone:808-372-7060
Mailing Address - Fax:
Practice Address - Street 1:600 QUEEN ST STE C2
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5113
Practice Address - Country:US
Practice Address - Phone:808-377-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIRS-2501OtherREAL ESTATE LICENSE