1346307410 NPI number — MS. HEATHER LEIGH CULPEPPER P.T.

Table of content: OLGA MYSZKO M.D. (NPI 1013448455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346307410 NPI number — MS. HEATHER LEIGH CULPEPPER P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CULPEPPER
Provider First Name:
HEATHER
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346307410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
571 MIKIOI PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIHEI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96753-9458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-250-5761
Provider Business Mailing Address Fax Number:
808-891-1188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 MAHALANI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-243-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT2017 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00C0235469 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 203328187 . This is a "TRICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".