Healthcare Provider Details

I. General information

NPI: 1770228215
Provider Name (Legal Business Name): KRISTINA HERRIOTT KRUSE AGACNP-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 IWILEI RD STE 660
HONOLULU HI
96817-5392
US

IV. Provider business mailing address

47-422 HUI AUKUU PL
KANEOHE HI
96744-4652
US

V. Phone/Fax

Practice location:
  • Phone: 808-924-9255
  • Fax: 808-922-9161
Mailing address:
  • Phone: 217-778-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN110698
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberAPRN3948
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN3948
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: