Provider Demographics
NPI:1164129029
Name:SERGENT, LAUREN (LMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SERGENT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:DEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 ULUNIU ST STE 2
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2529
Mailing Address - Country:US
Mailing Address - Phone:808-262-4550
Mailing Address - Fax:855-594-5059
Practice Address - Street 1:320 ULUNIU ST STE 2
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2529
Practice Address - Country:US
Practice Address - Phone:808-262-4550
Practice Address - Fax:855-594-5059
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-17333225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist