Healthcare Provider Details

I. General information

NPI: 1053419457
Provider Name (Legal Business Name): CHRISTINA LEE HAZAMA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD TRIPLER OBGYN CLINIC
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD TRIPLER OBGYN CLINIC
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-6621
  • Fax: 808-433-1552
Mailing address:
  • Phone: 808-433-6621
  • Fax: 808-433-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 59205
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN 939
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: