Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN-1985 | HI |
N | 363LG0600X | Nurse Practitioner - Gerontology | APRN-1985 | HI |
NPI | 1013388735 |
---|---|
Provider Name | Ryan Tenn |
First Address | Laie, HI 96762-1138 |
Second Address | Laie, HI 96762-1138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2015 |
Last Update Date | 25/01/2016 |