Provider Demographics
NPI:1124193578
Name:HAERER, BETTINA WONG (MD)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:WONG
Last Name:HAERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 WILI PA LOOP STE 7
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1271
Mailing Address - Country:US
Mailing Address - Phone:808-249-2121
Mailing Address - Fax:808-242-8920
Practice Address - Street 1:1787 WILI PA LOOP STE 7
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1271
Practice Address - Country:US
Practice Address - Phone:808-249-2121
Practice Address - Fax:808-242-8920
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-117712084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry