MEDICARE: DONNA E BURNETT PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY706	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	123666400	OTHER		DEPT OF LABOR
2	A0023539	OTHER	HI	HMSA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659391001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA E BURNETT PSYD

Provider Business Mailing Address
First Line	:	415 ILIMANO ST
Second Line	:
City	:	KAILUA
State	:	HI
Zip	:	96734
Country	:	US
Telephone Number	:	808-254-5122
Fax Number	:	808-254-5122

Provider Business Practice Location Address
First Line	:	45-955 KAMEHAMEHA HWY
Second Line	:	STE 202
City	:	KANEOHE
State	:	HI
Zip	:	96744-3222
Country	:	US
Telephone Number	:	808-254-5122
Fax Number	:	808-254-5122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	05/21/2010

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Directions to “ DONNA E BURNETT PSYD” Practice Location

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