=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770228215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTINA HERRIOTT KRUSE AGACNP-CNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2022
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 IWILEI RD STE 660
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-5392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-924-9255
-----------------------------------------------------
Fax | 808-922-9161
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47-422 HUI AUKUU PL
-----------------------------------------------------
City | KANEOHE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96744-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-778-5332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH1000X
-----------------------------------------------------
Taxonomy Name | Hospice Registered Nurse
-----------------------------------------------------
License Number | RN110698
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Clinical Nurse Specialist
-----------------------------------------------------
License Number | APRN3948
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN3948
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------