Basic Information
| Provider Information | |||||||||
| NPI: | 1528283801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TESORO DANG | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95-192 MOHAI PL | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967891221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087543043 | ||||||||
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| Practice Location | |||||||||
| Address1: | 86-260 FARRINGTON HWY | ||||||||
| Address2: | |||||||||
| City: | WAIANAE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967923128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086973300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN-613 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0000258426 | 01 | HI | HMSA PROVIDER NUMBER | OTHER | 8670783 | 01 | HI | UHA PIN NUMBER | OTHER | 57802301 | 01 | HI | ALOHA CARE PROVIDER NUMBE | OTHER |