Provider Demographics
NPI:1699295295
Name:PETITH-ZBICIAK, CAROL TERESA (DNP, APRN - RX)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:TERESA
Last Name:PETITH-ZBICIAK
Suffix:
Gender:F
Credentials:DNP, APRN - RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-0150
Mailing Address - Country:US
Mailing Address - Phone:808-573-0630
Mailing Address - Fax:
Practice Address - Street 1:310 W. KAAHUMANU AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1617
Practice Address - Country:US
Practice Address - Phone:808-984-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner