Provider Demographics
NPI:1528222825
Name:STIASTNY, MAUREEN ELIZABETH (LMT,LAC,MACOM)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:STIASTNY
Suffix:
Gender:F
Credentials:LMT,LAC,MACOM
Other - Prefix:MS
Other - First Name:MAURGANA
Other - Middle Name:
Other - Last Name:STIASTNY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT,LAC,MACOM
Mailing Address - Street 1:104A IKE DR
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9716
Mailing Address - Country:US
Mailing Address - Phone:808-579-8810
Mailing Address - Fax:808-579-8290
Practice Address - Street 1:104A IKE DR
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9716
Practice Address - Country:US
Practice Address - Phone:808-579-8810
Practice Address - Fax:808-579-8290
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU488171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist