Healthcare Provider Details

I. General information

NPI: 1861778805
Provider Name (Legal Business Name): TERESA LOUISE BRINK WONG RN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 540
HONOLULU HI
96826-1046
US

IV. Provider business mailing address

1319 PUNAHOU ST STE 540
HONOLULU HI
96826-1046
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8559
  • Fax: 808-983-8559
Mailing address:
  • Phone: 808-983-8559
  • Fax: 808-983-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN24083
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: