Healthcare Provider Details

I. General information

NPI: 1336100049
Provider Name (Legal Business Name): J D WAILUA BRANDMAN APRN PMHCNS/NP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JD WAILUA BRANDMAN APRN

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI ST SUITE 1406
HONOLULU HI
96814-3116
US

IV. Provider business mailing address

615 PIIKOI ST SUITE 1406
HONOLULU HI
96814-3116
US

V. Phone/Fax

Practice location:
  • Phone: 808-593-7703
  • Fax: 808-593-7703
Mailing address:
  • Phone: 808-593-7703
  • Fax: 808-593-7703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN13
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: