MEDICARE: ALLYSON RAE BENDER ARN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	18145	SC
2	363LF0000X	Family Nurse Practitioner	APRN-2809	HI

General Provider Information

NPI Number	:	1588903397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON RAE BENDER ARN

Provider Business Mailing Address
First Line	:	2155 KALAKAUA AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96815-2351
Country	:	US
Telephone Number	:	808-922-6739
Fax Number	:

Provider Business Practice Location Address
First Line	:	2155 KALAKAUA AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96815-2351
Country	:	US
Telephone Number	:	808-922-6739
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2013
Last Update Date	:	05/25/2021

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