Provider Demographics
NPI:1285429829
Name:WANA, ALEXIS BROOKE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BROOKE
Last Name:WANA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74-217 ILILOA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3304
Mailing Address - Country:US
Mailing Address - Phone:808-731-9368
Mailing Address - Fax:
Practice Address - Street 1:1130 ALA MOANA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-585-1424
Practice Address - Fax:808-585-0379
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician