Provider Demographics
NPI:1336849645
Name:GRANITE, AMBER KAPUAMAKAMAEOKALANI (ILC, GPCE)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:KAPUAMAKAMAEOKALANI
Last Name:GRANITE
Suffix:
Gender:F
Credentials:ILC, GPCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-1347 KALANIANAOLE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1297
Mailing Address - Country:US
Mailing Address - Phone:808-259-7940
Mailing Address - Fax:808-954-1768
Practice Address - Street 1:41-1347 KALANIANAOLE HWY STE A
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1297
Practice Address - Country:US
Practice Address - Phone:808-259-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator