Provider Demographics
NPI:1659391001
Name:BURNETT, DONNA E (PSYD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:E
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ILIMANO ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-254-5122
Mailing Address - Fax:808-254-5122
Practice Address - Street 1:45-955 KAMEHAMEHA HWY
Practice Address - Street 2:STE 202
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3222
Practice Address - Country:US
Practice Address - Phone:808-254-5122
Practice Address - Fax:808-254-5122
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY706103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
123666400OtherDEPT OF LABOR
HIA0023539OtherHMSA
HI50033101Medicaid
123666400OtherDEPT OF LABOR