1336100049 NPI number — MR. J D WAILUA BRANDMAN APRN PMHCNS/NP-BC

Table of content: MR. J D WAILUA BRANDMAN APRN PMHCNS/NP-BC (NPI 1336100049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336100049 NPI number — MR. J D WAILUA BRANDMAN APRN PMHCNS/NP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANDMAN
Provider First Name:
J D
Provider Middle Name:
WAILUA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APRN PMHCNS/NP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRANDMAN
Provider Other First Name:
JD WAILUA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336100049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 PIIKOI ST
Provider Second Line Business Mailing Address:
SUITE 1406
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-3116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-593-7703
Provider Business Mailing Address Fax Number:
808-593-7703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 PIIKOI ST
Provider Second Line Business Practice Location Address:
SUITE 1406
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-593-7703
Provider Business Practice Location Address Fax Number:
808-593-7703
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  APRN13 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A0217578 . This is a "HMSA/BCBS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: BF505Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 25092001 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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