Healthcare Provider Details

I. General information

NPI: 1124355003
Provider Name (Legal Business Name): STACY LYNN KRACHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N NIMITZ HWY
HONOLULU HI
96819-2218
US

IV. Provider business mailing address

155 PAOAKALANI AVE APT 601
HONOLULU HI
96815-3703
US

V. Phone/Fax

Practice location:
  • Phone: 808-845-2018
  • Fax: 808-845-3729
Mailing address:
  • Phone: 808-688-6947
  • Fax: 808-845-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number717
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: