Healthcare Provider Details

I. General information

NPI: 1205837812
Provider Name (Legal Business Name): SUZANNA VALERIE A.P.R.N., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19-4202 KEKOANUI BLVD.
VOLCANO HI
96785
US

IV. Provider business mailing address

PO BOX 635
VOLCANO HI
96785
US

V. Phone/Fax

Practice location:
  • Phone: 808-896-5661
  • Fax: 808-985-9221
Mailing address:
  • Phone: 808-896-5661
  • Fax: 808-985-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN 25
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN 25
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: