Provider Demographics
NPI:1124608674
Name:MOSER, LAUREN (LAC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MOSER
Suffix:
Gender:F
Credentials: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 1479
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1479
Mailing Address - Country:US
Mailing Address - Phone:808-269-2083
Mailing Address - Fax:
Practice Address - Street 1:2450 KEKAULIKE AVE
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790
Practice Address - Country:US
Practice Address - Phone:808-269-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-1220171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist