Provider Demographics
NPI:1205837812
Name:VALERIE, SUZANNA (APRN, NP)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:VALERIE
Suffix:
Gender:F
Credentials:APRN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785
Mailing Address - Country:US
Mailing Address - Phone:808-896-5661
Mailing Address - Fax:808-985-9221
Practice Address - Street 1:19-4202 KEKOANUI BLVD.
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:HI
Practice Address - Zip Code:96785
Practice Address - Country:US
Practice Address - Phone:808-896-5661
Practice Address - Fax:808-985-9221
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 25363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52210301Medicaid
218347OtherHMSA
HI52210301Medicaid
218347OtherHMSA