Healthcare Provider Details

I. General information

NPI: 1184606899
Provider Name (Legal Business Name): AMY J DUERLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16-192 PILI MUA ST
KEAAU HI
96749-8134
US

IV. Provider business mailing address

64-1032 MAMALAHOA HWY 306
KAMUELA HI
96743-8441
US

V. Phone/Fax

Practice location:
  • Phone: 808-930-0400
  • Fax: 808-966-4028
Mailing address:
  • Phone: 808-769-5010
  • Fax: 808-769-5208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN 841
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: