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General NPI Number Information
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NPI Number | 1558606756
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Entity Type | Individual
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Provider Name | BRONWEN STEPHANIE PETERNELL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 1135 MAKAWAO AVE STE 202
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City | MAKAWAO
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State | HI
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Zip | 96768-7403
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Country | US
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Telephone | 808-495-7681
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Fax | 949-655-5945
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Provider Business Mailing Address
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Address Line | PO BOX 1325
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City | MAKAWAO
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State | HI
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Zip | 96768-1325
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Country | US
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Telephone | 808-495-7681
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Fax | 949-655-5945
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F337619
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21431
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3455-0
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License Number State | HI
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