Healthcare Provider Details

I. General information

NPI: 1710441266
Provider Name (Legal Business Name): ANDREA KERN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2499
US

IV. Provider business mailing address

10101 GROSVENOR PL APT 1202
ROCKVILLE MD
20852-4676
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-8459
  • Fax:
Mailing address:
  • Phone: 727-743-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11010573
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR229665
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: