Provider Demographics
NPI:1487978425
Name:HALTINER, HEIDI MARIE
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:MARIE
Last Name:HALTINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3566A PIIKEA PL
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9550
Mailing Address - Country:US
Mailing Address - Phone:808-357-0181
Mailing Address - Fax:
Practice Address - Street 1:40 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1718
Practice Address - Country:US
Practice Address - Phone:808-242-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT11605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist