=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073055752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDON MICHAEL FRIEDMAN DNP, MBA, APRN-RX
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2016
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 UNIVERSITY AVE STE 6A
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826-1509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-214-7236
-----------------------------------------------------
Fax | 808-427-3589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2838 E MANOA RD
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96822-1822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-214-7236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2202
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------