Provider Demographics
NPI:1306360243
Name:WASIUTYNSKI, ALEKSANDRA
Entity Type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:
Last Name:WASIUTYNSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PUANANI PL
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8487
Mailing Address - Country:US
Mailing Address - Phone:475-689-1479
Mailing Address - Fax:
Practice Address - Street 1:201 PUANANI PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8487
Practice Address - Country:US
Practice Address - Phone:475-689-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15274225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist