Provider Demographics
NPI:1992988851
Name:TANUMIHARDJA, MAUREEN (APRN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:TANUMIHARDJA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S BERETANIA ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2423
Mailing Address - Country:US
Mailing Address - Phone:808-691-8877
Mailing Address - Fax:808-691-8875
Practice Address - Street 1:550 S BERETANIA ST STE 601
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2423
Practice Address - Country:US
Practice Address - Phone:808-691-8877
Practice Address - Fax:808-691-8875
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007568363LF0000X
HIAPRN-3174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily