MEDICARE: TERRI LYN PACHECO FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1534	HI

General Provider Information

NPI Number	:	1306185954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI LYN PACHECO FNP-C

Provider Business Mailing Address
First Line	:	91-2135 FORT WEAVER RD
Second Line	:	SUITE 170
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1940
Country	:	US
Telephone Number	:	808-676-5331
Fax Number	:	808-671-2931

Provider Business Practice Location Address
First Line	:	91-2135 FT. WEAVER ROAD
Second Line	:	SUITE 150
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1929
Country	:	US
Telephone Number	:	808-676-5331
Fax Number	:	808-671-2931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2013
Last Update Date	:	01/29/2015

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