Provider Demographics
NPI:1467695726
Name:BANZIGER, LINDA (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BANZIGER
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 KOKOMO RD
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5028
Mailing Address - Country:US
Mailing Address - Phone:808-572-3590
Mailing Address - Fax:480-393-5408
Practice Address - Street 1:2187 KOKOMO RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5028
Practice Address - Country:US
Practice Address - Phone:808-572-3590
Practice Address - Fax:480-393-5408
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 1395363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner