Healthcare Provider Details

I. General information

NPI: 1013363316
Provider Name (Legal Business Name): BRYANA MIYABARA-TRESCHUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 ALA MOANA BLVD STE 261
HONOLULU HI
96813-4924
US

IV. Provider business mailing address

1364 ALA MAHAMOE ST
HONOLULU HI
96819-1700
US

V. Phone/Fax

Practice location:
  • Phone: 808-888-4736
  • Fax:
Mailing address:
  • Phone: 808-208-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN - 1688
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN - 1688
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN - 69133
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: