Basic Information
| Provider Information | |||||||||
| NPI: | 1508326018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUSICK | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | EIKO | ||||||||
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| Credential: | CNM, APRN, IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4351 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939214351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082842445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1319 PUNAHOU ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968261001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089836000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2019 | ||||||||
| LastUpdateDate: | 03/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | L-10926 | VA | N | Nursing Service Providers | Registered Nurse | Lactation Consultant | 207VX0000X | 1934 | HI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.