Provider Demographics
NPI:1922398163
Name:MCGRATH, SUWAN KHAMKHUN (APRN)
Entity Type:Individual
Prefix:MS
First Name:SUWAN
Middle Name:KHAMKHUN
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 KILOU ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-9753
Mailing Address - Country:US
Mailing Address - Phone:808-242-7235
Mailing Address - Fax:808-242-7235
Practice Address - Street 1:1370 KILOU ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-9753
Practice Address - Country:US
Practice Address - Phone:808-242-7235
Practice Address - Fax:808-242-7235
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN - 1249364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult