Healthcare Provider Details

I. General information

NPI: 1417690025
Provider Name (Legal Business Name): TERRI TAKAYESU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRI PULE

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 KINOOLE ST
HILO HI
96720-5744
US

IV. Provider business mailing address

PO BOX 696
KEAAU HI
96749-0696
US

V. Phone/Fax

Practice location:
  • Phone: 808-979-4080
  • Fax:
Mailing address:
  • Phone: 808-979-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4690
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: