MEDICARE: BRENNA KUUPILIALOHA LEWIS

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	104100000X	Social Worker		HI

General Provider Information

NPI Number	:	1376151076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA KUUPILIALOHA LEWIS

Provider Business Mailing Address
First Line	:	1822 KEEAUMOKU ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-3001
Country	:	US
Telephone Number	:	808-521-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	2848 PARK ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-1157
Country	:	US
Telephone Number	:	808-595-0111
Fax Number	:

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

Provider Enumeration Date	:	07/19/2020
Last Update Date	:	07/19/2020

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