Provider Demographics
NPI:1376804377
Name:GRAVES, KRISTA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:GRAVES
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 1:6167 MAKANIOLU PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2350
Mailing Address - Country:US
Mailing Address - Phone:808-927-5767
Mailing Address - Fax:
Practice Address - Street 1:1600 KAPIOLANI BLVD
Practice Address - Street 2:#1421
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3801
Practice Address - Country:US
Practice Address - Phone:808-927-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-652171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist