Provider Demographics
NPI:1700372836
Name:ASTUMIAN, HEATHER SUZANNE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUZANNE
Last Name:ASTUMIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:SUZANNE
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1720 ALA MOANA BLVD APT 1401B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1348
Mailing Address - Country:US
Mailing Address - Phone:720-660-5293
Mailing Address - Fax:877-436-3472
Practice Address - Street 1:1720 ALA MOANA BLVD APT 1401B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1348
Practice Address - Country:US
Practice Address - Phone:720-660-5293
Practice Address - Fax:877-436-3472
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19220164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI19220OtherLICENSE