Basic Information
| Provider Information | |||||||||
| NPI: | 1740632272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIGA | ||||||||
| FirstName: | DEANNE | ||||||||
| MiddleName: | SAMESHIMA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SAMESHIMA | ||||||||
| OtherFirstName: | DEANNE | ||||||||
| OtherMiddleName: | MIYO OHATA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 221 AINAKO AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967201603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082800043 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1190 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089323186 | ||||||||
| FaxNumber: | 8089324303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 03/05/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DOS-2204-0 | HI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | WA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.