Provider Demographics
NPI:1376565218
Name:CRITZ, CATHARINE M (PHD, CPNP)
Entity Type:Individual
Prefix:
First Name:CATHARINE
Middle Name:M
Last Name:CRITZ
Suffix:
Gender:F
Credentials:PHD, CPNP
Other - Prefix:
Other - First Name:CATHARINE
Other - Middle Name:C
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:797 KAINUI DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2095
Mailing Address - Country:US
Mailing Address - Phone:808-265-4561
Mailing Address - Fax:
Practice Address - Street 1:797 KAINUI DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2095
Practice Address - Country:US
Practice Address - Phone:808-265-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI263363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000220723OtherHMSA BILLING NUMBER
HI54310901Medicaid
HI54310901Medicaid
HIH52651Medicare PIN