Provider Demographics
NPI:1215282488
Name:YANNELL, IAN E (LAC)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:E
Last Name:YANNELL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 LOULU WAY
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8908
Mailing Address - Country:US
Mailing Address - Phone:808-280-9001
Mailing Address - Fax:
Practice Address - Street 1:30 AHUWALE PL
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8860
Practice Address - Country:US
Practice Address - Phone:808-344-9826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI965171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist