Provider Demographics
NPI:1336224229
Name:BASTON, DAN (APRN)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:BASTON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MAKAWAO AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8859
Mailing Address - Country:US
Mailing Address - Phone:808-573-8900
Mailing Address - Fax:808-572-3027
Practice Address - Street 1:81 MAKAWAO AVE STE 25
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8859
Practice Address - Country:US
Practice Address - Phone:808-573-8900
Practice Address - Fax:808-572-3027
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000255851OtherHMSA NUMBER
HI101069Medicare ID - Type Unspecified
HI0000255851OtherHMSA NUMBER