Healthcare Provider Details

I. General information

NPI: 1467695726
Provider Name (Legal Business Name): LINDA BANZIGER FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2187 KOKOMO RD
HAIKU HI
96708-5028
US

IV. Provider business mailing address

2187 KOKOMO RD
HAIKU HI
96708-5028
US

V. Phone/Fax

Practice location:
  • Phone: 808-572-3590
  • Fax: 480-393-5408
Mailing address:
  • Phone: 808-572-3590
  • Fax: 480-393-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN 1395
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: