Provider Demographics
NPI:1891267753
Name:HERMAWAN, ARDI (APRN)
Entity type:Individual
Prefix:
First Name:ARDI
Middle Name:
Last Name:HERMAWAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-056 KAMEHAMEHA HWY STE 221
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-6706
Mailing Address - Country:US
Mailing Address - Phone:808-233-6200
Mailing Address - Fax:
Practice Address - Street 1:46-056 KAMEHAMEHA HWY STE 221
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-6706
Practice Address - Country:US
Practice Address - Phone:808-233-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3535363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care