Healthcare Provider Details

I. General information

NPI: 1710673728
Provider Name (Legal Business Name): PATRICK BERTULFO FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD
HONOLULU HI
96813-4920
US

IV. Provider business mailing address

98-429 KAAMILO ST
AIEA HI
96701-4313
US

V. Phone/Fax

Practice location:
  • Phone: 407-306-8441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-3701
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: