Healthcare Provider Details

I. General information

NPI: 1942811997
Provider Name (Legal Business Name): RAQUIEL ANDERSEN DNP, FNP-C, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5922B GANNET AVE
EWA BEACH HI
96706-3212
US

IV. Provider business mailing address

5922B GANNET AVE
EWA BEACH HI
96706-3212
US

V. Phone/Fax

Practice location:
  • Phone: 808-746-9247
  • Fax:
Mailing address:
  • Phone: 808-746-9247
  • Fax: 689-212-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-3248
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number227558
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-3248
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227558
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: