Provider Demographics
NPI:1134429830
Name:WINGATE, CATHRINE REBECCA ANN (LAC)
Entity type:Individual
Prefix:
First Name:CATHRINE
Middle Name:REBECCA ANN
Last Name:WINGATE
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 1:36 KOMOHANA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2008
Mailing Address - Country:US
Mailing Address - Phone:808-238-0338
Mailing Address - Fax:808-238-0410
Practice Address - Street 1:36 KOMOHANA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2008
Practice Address - Country:US
Practice Address - Phone:808-238-0338
Practice Address - Fax:808-238-0410
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU 933171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist