Provider Demographics
NPI:1316180714
Name:HIRATA, HEATHER JILL (BC-APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JILL
Last Name:HIRATA
Suffix:
Gender:F
Credentials:BC-APRN
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 1282
Mailing Address - Street 2:
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760-1282
Mailing Address - Country:US
Mailing Address - Phone:808-968-8226
Mailing Address - Fax:
Practice Address - Street 1:868 ULULANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3913
Practice Address - Country:US
Practice Address - Phone:808-960-0006
Practice Address - Fax:808-329-9260
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily