Basic Information
Provider Information
NPI: 1629474069
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ERLENBACH
FirstName: RYAN
MiddleName: JAMES
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1215 HUNAKAI ST
Address2:  
City: HONOLULU
State: HI
PostalCode: 968164661
CountryCode: US
TelephoneNumber: 8089224787
FaxNumber:  
Practice Location
Address1: 1215 HUNAKAI ST
Address2:  
City: HONOLULU
State: HI
PostalCode: 968164661
CountryCode: US
TelephoneNumber: 8089224787
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/12/2014
LastUpdateDate: 07/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN-1829HIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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