Healthcare Provider Details

I. General information

NPI: 1881687044
Provider Name (Legal Business Name): SUSANNA JANE WESTBROOK CMN,MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N KING ST
HONOLULU HI
96817-4544
US

IV. Provider business mailing address

1604 QUINCY PL
HONOLULU HI
96816-2020
US

V. Phone/Fax

Practice location:
  • Phone: 808-848-1438
  • Fax: 808-841-1265
Mailing address:
  • Phone: 808-226-9976
  • Fax: 808-841-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0000010494
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: