Provider Demographics
NPI:1013363316
Name:MIYABARA-TRESCHUK, BRYANA
Entity Type:Individual
Prefix:
First Name:BRYANA
Middle Name:
Last Name:MIYABARA-TRESCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 ALA MAHAMOE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1700
Mailing Address - Country:US
Mailing Address - Phone:808-208-6509
Mailing Address - Fax:
Practice Address - Street 1:521 ALA MOANA BLVD STE 261
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4924
Practice Address - Country:US
Practice Address - Phone:808-888-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN - 1688363LA2200X, 363L00000X
HIRN - 69133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse