Healthcare Provider Details

I. General information

NPI: 1558833111
Provider Name (Legal Business Name): FRANCES ASTORGA BACCHUS MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N HOLOPONO ST STE 215
KIHEI HI
96753-6945
US

IV. Provider business mailing address

1300 N HOLOPONO ST STE 215
KIHEI HI
96753-6945
US

V. Phone/Fax

Practice location:
  • Phone: 808-874-3444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-2567
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: