Provider Demographics
NPI:1649926346
Name:ANDERSON, PUAMAEOLE (LMT)
Entity type:Individual
Prefix:
First Name:PUAMAEOLE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 PAKELE LN
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4823
Mailing Address - Country:US
Mailing Address - Phone:808-990-8089
Mailing Address - Fax:
Practice Address - Street 1:73 PUUHONU PL STE 104
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2060
Practice Address - Country:US
Practice Address - Phone:808-935-6353
Practice Address - Fax:888-511-6031
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program