Provider Demographics
NPI:1023591468
Name:HENDRICKSON, TIANNA (BA, MAC, LAC)
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:BA, MAC, LAC
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 800253
Mailing Address - Street 2:
Mailing Address - City:PAPAALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96780-0250
Mailing Address - Country:US
Mailing Address - Phone:424-237-4422
Mailing Address - Fax:
Practice Address - Street 1:3595 PAPAALOA RD
Practice Address - Street 2:
Practice Address - City:PAPAALOA
Practice Address - State:HI
Practice Address - Zip Code:96780-9678
Practice Address - Country:US
Practice Address - Phone:424-237-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-1238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist