Provider Demographics
NPI:1336413814
Name:BASS, COLLEEN (WHNP, CNM)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:WHNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-1558 KUHIO HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746
Mailing Address - Country:US
Mailing Address - Phone:808-631-2682
Mailing Address - Fax:866-423-3332
Practice Address - Street 1:4-1558 KUHIO HIGHWAY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746
Practice Address - Country:US
Practice Address - Phone:808-631-2682
Practice Address - Fax:866-423-3332
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN1437367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife