Provider Demographics
NPI:1104208271
Name:ACKERMAN, MARY JILL (LAC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JILL
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5101 PALAOLE PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1530
Mailing Address - Country:US
Mailing Address - Phone:808-377-1903
Mailing Address - Fax:808-377-1903
Practice Address - Street 1:3660 WAIALAE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3257
Practice Address - Country:US
Practice Address - Phone:808-942-1144
Practice Address - Fax:808-942-1142
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILAC1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist