Healthcare Provider Details

I. General information

NPI: 1194232116
Provider Name (Legal Business Name): HEATHER BECKER-BRUNGARD ND, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 KAPIOLANI ST
HILO HI
96720-7825
US

IV. Provider business mailing address

192 KAPIOLANI ST
HILO HI
96720-7825
US

V. Phone/Fax

Practice location:
  • Phone: 808-300-2432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4091
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC184705
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number315
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1304
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: