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General NPI Number Information
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NPI Number | 1306267935
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Entity Type | Individual
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Provider Name | BRYSCEN PROTHERO APRN-RX, PNP
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Gender | Male
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Dates
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Enumeration Date | 12/28/2013
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Last Update Date | 12/28/2013
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Provider Practice Location Address
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Address Line | 91-1089 KAIKO ST
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City | EWA BEACH
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State | HI
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Zip | 96706-6035
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Country | US
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Telephone | 808-741-8186
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Fax |
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Provider Business Mailing Address
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Address Line | 91-1089 KAIKO ST
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City | EWA BEACH
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State | HI
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Zip | 96706-6035
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Country | US
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Telephone | 808-741-8186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1672
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License Number State | HI
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