Healthcare Provider Details

I. General information

NPI: 1184939613
Provider Name (Legal Business Name): JOHANN ROSS HEPNER PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD STE 1600
HONOLULU HI
96814-4407
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD STE 1600
HONOLULU HI
96814-4407
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-7600
  • Fax:
Mailing address:
  • Phone: 808-432-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2258601
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-2285
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: