Basic Information
| Provider Information | |||||||||
| NPI: | 1295357978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINTON-DIGGS | ||||||||
| FirstName: | BRHIANNON | ||||||||
| MiddleName: | LYNNAE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WINTON-DIGGS | ||||||||
| OtherFirstName: | BRHIANNON | ||||||||
| OtherMiddleName: | LYNNAE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 98-1657 HOOLAUAE ST | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967011802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056107348 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 203 KAPAA QUARRY PL | ||||||||
| Address2: | #5002 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087412232 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2020 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 106E00000X | Y |
No ID Information.