Healthcare Provider Details

I. General information

NPI: 1083466940
Provider Name (Legal Business Name): REBEKAH MAZAC DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1051 FRANKLIN D ROOSEVELT AVE
KAPOLEI HI
96707-2185
US

IV. Provider business mailing address

1829 37TH ST
FORT HOOD TX
76544-2336
US

V. Phone/Fax

Practice location:
  • Phone: 808-458-5065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-4816
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: