Provider Demographics
NPI:1306267935
Name:PROTHERO, BRYSCEN (APRN-RX, PNP)
Entity type:Individual
Prefix:
First Name:BRYSCEN
Middle Name:
Last Name:PROTHERO
Suffix:
Gender:M
Credentials:APRN-RX, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1089 KAIKO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6035
Mailing Address - Country:US
Mailing Address - Phone:808-741-8186
Mailing Address - Fax:
Practice Address - Street 1:91-1089 KAIKO ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6035
Practice Address - Country:US
Practice Address - Phone:808-741-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-28
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1672363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics