Provider Demographics
NPI:1467819003
Name:HASTANAN, AMY L (LAC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:HASTANAN
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 1:1614 IHILOA LOOP
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1320
Mailing Address - Country:US
Mailing Address - Phone:808-989-1003
Mailing Address - Fax:
Practice Address - Street 1:1144 KOKO HEAD AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3799
Practice Address - Country:US
Practice Address - Phone:808-989-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21658225700000X
HI12819225700000X
OR178049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist