Healthcare Provider Details

I. General information

NPI: 1174890107
Provider Name (Legal Business Name): ERIK DRU ANDERSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 05/17/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LILIHA ST STE 601
HONOLULU HI
96817-3564
US

IV. Provider business mailing address

1520 LILIHA ST STE 601
HONOLULU HI
96817-3564
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-0445
  • Fax:
Mailing address:
  • Phone: 775-322-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1399
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1399
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: