Provider Demographics
NPI:1467511881
Name:AUSTIN, LEE (CRNA, APRN)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W HIND DR STE 114
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1845
Mailing Address - Country:US
Mailing Address - Phone:808-784-0007
Mailing Address - Fax:808-501-0886
Practice Address - Street 1:850 W HIND DR STE 114
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-784-0007
Practice Address - Fax:808-501-0886
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-79220163W00000X
CARN592567163W00000X
CANA2796367500000X
HIAPRN-1981367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANA0027960OtherBLUE SHIELD OF CA
CA359252000OtherUS DEPT OF LABOR
CARN5925670Medicaid
CARN5925670Medicaid
CANA0027960OtherBLUE SHIELD OF CA