Provider Demographics
NPI:1750836193
Name:VANCE BEAUMONT, DEBORAH (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:VANCE BEAUMONT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS
Mailing Address - Street 1:75-5995 KUAKINI HWY STE 445
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2123
Mailing Address - Country:US
Mailing Address - Phone:808-315-8466
Mailing Address - Fax:
Practice Address - Street 1:75-5995 KUAKINI HWY STE 445
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2123
Practice Address - Country:US
Practice Address - Phone:808-315-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2154364SA2200X
CA4427364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health