Provider Demographics
NPI:1235576786
Name:MCMENEMY, DEBORAH J (LAC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:MCMENEMY
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 1:33 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1702
Mailing Address - Country:US
Mailing Address - Phone:808-868-6052
Mailing Address - Fax:888-241-9190
Practice Address - Street 1:33 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1702
Practice Address - Country:US
Practice Address - Phone:808-868-6052
Practice Address - Fax:888-241-9190
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14076171100000X
HIACU-932171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist