Provider Demographics
NPI:1447426812
Name:CORNETT, MARTIN W (CRNA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:W
Last Name:CORNETT
Suffix:
Gender:M
Credentials:CRNA
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 1840
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-1840
Mailing Address - Country:US
Mailing Address - Phone:808-325-6760
Mailing Address - Fax:808-443-0159
Practice Address - Street 1:640 ULUKAHIKI ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4454
Practice Address - Country:US
Practice Address - Phone:808-263-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1083367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH103755Medicare PIN