Healthcare Provider Details

I. General information

NPI: 1740296995
Provider Name (Legal Business Name): TESA LINDSTROM STARK CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 MAKUAKANE ST MEDICAL SERVICES-HALE OLA
HONOLULU HI
96817-1800
US

IV. Provider business mailing address

1887 MAKUAKANE ST MEDICAL SERVICES-HALE OLA
HONOLULU HI
96817-1800
US

V. Phone/Fax

Practice location:
  • Phone: 808-842-8075
  • Fax:
Mailing address:
  • Phone: 808-842-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number648059
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1290
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: