Healthcare Provider Details

I. General information

NPI: 1497594980
Provider Name (Legal Business Name): BRENNA JEAN RYAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 MOANALUA RD
HONOLULU HI
96819-1469
US

IV. Provider business mailing address

1 JARRETT WHITE RD, MCHK-OB DEPARTMENT OF OB GYN
TRIPLER ARMY MEDICAL CENTER HI
96859-5000
US

V. Phone/Fax

Practice location:
  • Phone: 808-265-9205
  • Fax:
Mailing address:
  • Phone: 808-433-2810
  • Fax: 808-433-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: