Doctor Name: | TIFFANY TAKUSHI |
NPI Number: | 1073940979 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | APRN1620 |
Business Practice Address: | 98-1005 Moanalua Rd #400 Aiea, HI - 967014777 |
Business Phone Number: | 8663892727 |
Business Fax Number: | |
Mailing Address: | 98-1005 Moanalua Rd, #400 AIEA |
State: | HI |
Postal Code: | 967014777 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/09/2013 |
NPI Last Update Date: | 05/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APRN1620 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |