Provider Demographics
NPI:1679081046
Name:PUSATERI, LORI (LAC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:PUSATERI
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 426
Mailing Address - Street 2:
Mailing Address - City:PAPAIKOU
Mailing Address - State:HI
Mailing Address - Zip Code:96781-0426
Mailing Address - Country:US
Mailing Address - Phone:808-640-7766
Mailing Address - Fax:
Practice Address - Street 1:465 HINANO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4406
Practice Address - Country:US
Practice Address - Phone:808-640-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1184171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist