Provider Demographics
NPI:1518655190
Name:HALEAKALA, ELIZABETH NU'UMEALANI
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:NU'UMEALANI
Last Name:HALEAKALA
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 1:3535 STURGIS RD SIDE OF
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2345
Mailing Address - Country:US
Mailing Address - Phone:605-391-1678
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:3535 STURGIS RD SIDE OF
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2345
Practice Address - Country:US
Practice Address - Phone:605-391-1678
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist