Provider Demographics
NPI:1740292093
Name:TOUSMAN, AMY (RD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TOUSMAN
Suffix:
Gender:F
Credentials:RD
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 1408
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1408
Mailing Address - Country:US
Mailing Address - Phone:808-398-3813
Mailing Address - Fax:808-262-3813
Practice Address - Street 1:316 ULUNIU ST
Practice Address - Street 2:APT B
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2550
Practice Address - Country:US
Practice Address - Phone:808-398-3813
Practice Address - Fax:808-262-3813
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54272Medicare ID - Type Unspecified