Provider Demographics
NPI:1508681768
Name:LABISTRE, LAUREL
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:LABISTRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAUREL LABISTRE GENERAL DELIVERY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:HI
Mailing Address - Zip Code:96771
Mailing Address - Country:US
Mailing Address - Phone:808-785-7624
Mailing Address - Fax:
Practice Address - Street 1:157 KEAWE ST STE 159B
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2824
Practice Address - Country:US
Practice Address - Phone:808-785-7624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-18018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist