Provider Demographics
NPI:1851765234
Name:SOUZA, CARRIE KATHERINE
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:KATHERINE
Last Name:SOUZA
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:PO BOX 1618
Mailing Address - Street 2:
Mailing Address - City:HANALEI
Mailing Address - State:HI
Mailing Address - Zip Code:96714-1618
Mailing Address - Country:US
Mailing Address - Phone:808-828-0221
Mailing Address - Fax:
Practice Address - Street 1:4270 KILAUEA RD
Practice Address - Street 2:B
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5239
Practice Address - Country:US
Practice Address - Phone:808-828-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-22
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist