Provider Demographics
NPI:1437341559
Name:AMMERMAN, STACY RENEE (DO)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:RENEE
Last Name:AMMERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAA ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3603
Mailing Address - Country:US
Mailing Address - Phone:808-446-7120
Mailing Address - Fax:808-446-7121
Practice Address - Street 1:165 MA'A ST.
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732
Practice Address - Country:US
Practice Address - Phone:808-446-7120
Practice Address - Fax:808-446-7121
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1403207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology