Provider Demographics
NPI:1659440196
Name:HAUMEA, STACY (RDN CDE)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HAUMEA
Suffix:
Gender:F
Credentials:RDN CDE
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 4182
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-0182
Mailing Address - Country:US
Mailing Address - Phone:808-430-6735
Mailing Address - Fax:808-756-9555
Practice Address - Street 1:321 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2918
Practice Address - Country:US
Practice Address - Phone:808-430-6735
Practice Address - Fax:808-756-9555
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI47-LD133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102074Medicare PIN
HIH102072Medicare PIN
HIH102071Medicare PIN
HIH102073Medicare PIN