Provider Demographics
NPI:1144791070
Name:GARRISON, AMBER A (DACM, LAC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:A
Last Name:GARRISON
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 ULUNIU ST STE 404
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2534
Mailing Address - Country:US
Mailing Address - Phone:808-600-8010
Mailing Address - Fax:
Practice Address - Street 1:354 ULUNIU ST STE 404
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2534
Practice Address - Country:US
Practice Address - Phone:808-600-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1263171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty