Provider Demographics
NPI:1881687044
Name:WESTBROOK, SUSANNA JANE (CMN,MSN)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:JANE
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:CMN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 QUINCY PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2020
Mailing Address - Country:US
Mailing Address - Phone:808-226-9976
Mailing Address - Fax:808-841-1265
Practice Address - Street 1:915 N KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4544
Practice Address - Country:US
Practice Address - Phone:808-848-1438
Practice Address - Fax:808-841-1265
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000010494176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4100866OtherBCBS/BLUECARE/TCS
TN3495284Medicare ID - Type Unspecified