=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902270457
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAYOKO TREASHA HACKLER FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2015
-----------------------------------------------------
Last Update Date | 11/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 86-260 FARRINGTON HWY
-----------------------------------------------------
City | WAIANAE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96792-3128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-697-3850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95-1029 HOAMA ST
-----------------------------------------------------
City | MILILANI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96789-5532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-358-8982
-----------------------------------------------------
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 | APRN-2023
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------