Healthcare Provider Details

I. General information

NPI: 1164858155
Provider Name (Legal Business Name): ABIR AMIRDASH APRN, AG ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date: 06/24/2019
Reactivation Date: 07/10/2019

III. Provider practice location address

500 ALA MOANA BLVD
HONOLULU HI
96813-4920
US

IV. Provider business mailing address

47-435 HUI NENE ST
KANEOHE HI
96744-4640
US

V. Phone/Fax

Practice location:
  • Phone: 808-524-6115
  • Fax:
Mailing address:
  • Phone: 808-861-6684
  • Fax: 808-204-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN2122
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN2122
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN2122
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: