Provider Demographics
NPI:1578681797
Name:MARTIN, MICHAELA ANNWEN (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:ANNWEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ND, 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 1273
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-1273
Mailing Address - Country:US
Mailing Address - Phone:808-887-2020
Mailing Address - Fax:808-887-2021
Practice Address - Street 1:65-1267 KAWAIHAE RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8406
Practice Address - Country:US
Practice Address - Phone:808-887-2020
Practice Address - Fax:808-887-2021
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-595171100000X
HIND-126175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath