Healthcare Provider Details

I. General information

NPI: 1154630473
Provider Name (Legal Business Name): MANDI TE BENTON APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDI TE BENTON CUMMINGS APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST QUEENS HEART, PAUAHI 3
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

550 S BERETANIA ST STE 601
HONOLULU HI
96813-2423
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-4468
  • Fax:
Mailing address:
  • Phone: 808-429-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN-1301
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: