Provider Demographics
NPI:1790939700
Name:POWERS, LAURA ANN (LAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:POWERS
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 1:152 PUUEO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2429
Mailing Address - Country:US
Mailing Address - Phone:808-933-4325
Mailing Address - Fax:
Practice Address - Street 1:152 PUUEO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2429
Practice Address - Country:US
Practice Address - Phone:808-933-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU885171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist