Provider Demographics
NPI:1144794173
Name:BIRD, ANELA (LAC)
Entity Type:Individual
Prefix:
First Name:ANELA
Middle Name:
Last Name:BIRD
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 1:3265 PATY DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1449
Mailing Address - Country:US
Mailing Address - Phone:808-224-9662
Mailing Address - Fax:
Practice Address - Street 1:3265 PATY DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1449
Practice Address - Country:US
Practice Address - Phone:808-224-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1167171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist