Healthcare Provider Details

I. General information

NPI: 1588098552
Provider Name (Legal Business Name): PETRA ROESNER PHD HUMAN SERVICES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1841 FORT WEAVER RD
EWA BEACH HI
96706-1909
US

IV. Provider business mailing address

91-1841 FORT WEAVER RD
EWA BEACH HI
96706-1909
US

V. Phone/Fax

Practice location:
  • Phone: 808-681-3500
  • Fax: 808-681-1486
Mailing address:
  • Phone: 808-681-3500
  • Fax: 808-681-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: