Provider Demographics
NPI:1316991730
Name:HARPER, TERRI L (PAC)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:L
Last Name:HARPER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PAUAHI ST
Mailing Address - Street 2:SUITE #104
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3065
Mailing Address - Country:US
Mailing Address - Phone:808-933-3400
Mailing Address - Fax:808-933-3401
Practice Address - Street 1:80 PAUAHI ST
Practice Address - Street 2:SUITE #104
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3065
Practice Address - Country:US
Practice Address - Phone:808-933-3400
Practice Address - Fax:808-933-3401
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-231363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI24866-6OtherH.M.S.A.
HI55483301Medicaid
HI27096Medicare ID - Type Unspecified
HI24866-6OtherH.M.S.A.