Provider Demographics
NPI:1114553534
Name:GUILLERMO, TRISHA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:M
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4761 LIKINI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2249
Mailing Address - Country:US
Mailing Address - Phone:808-295-4956
Mailing Address - Fax:
Practice Address - Street 1:4761 LIKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-2249
Practice Address - Country:US
Practice Address - Phone:808-295-4956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI33158163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID6071152OtherWOUND CARE CERTIFIED