Provider Demographics
NPI:1972053411
Name:WIELAND, ANDREA (APRN - RX, FNP -C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WIELAND
Suffix:
Gender:F
Credentials:APRN - RX, FNP -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST STE 760
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1072
Mailing Address - Country:US
Mailing Address - Phone:808-947-5606
Mailing Address - Fax:808-947-5805
Practice Address - Street 1:1319 PUNAHOU ST STE 760
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1072
Practice Address - Country:US
Practice Address - Phone:808-947-5606
Practice Address - Fax:808-947-5805
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily