Healthcare Provider Details

I. General information

NPI: 1528283801
Provider Name (Legal Business Name): RENEE LYNN TESORO DANG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86-260 FARRINGTON HWY
WAIANAE HI
96792-3128
US

IV. Provider business mailing address

95-192 MOHAI PL
MILILANI HI
96789-1221
US

V. Phone/Fax

Practice location:
  • Phone: 808-697-3300
  • Fax:
Mailing address:
  • Phone: 808-754-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-613
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: