Healthcare Provider Details

I. General information

NPI: 1447445549
Provider Name (Legal Business Name): JERE MAPUANA GRAHAM APRN-BC RX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 AKIA RD STE A
KAPAA HI
96746-1615
US

IV. Provider business mailing address

6181 A KAWAIHAU RD.
KAPAA HI
96746-2613
US

V. Phone/Fax

Practice location:
  • Phone: 808-651-6779
  • Fax: 808-821-1670
Mailing address:
  • Phone: 808-651-6777
  • Fax: 808-821-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN257
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: