Provider Demographics
NPI:1164858155
Name:AMIRDASH, ABIR (APRN, AG ACNP)
Entity Type:Individual
Prefix:
First Name:ABIR
Middle Name:
Last Name:AMIRDASH
Suffix:
Gender:F
Credentials:APRN, AG ACNP
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:AMIRDASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:47-435 HUI NENE ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4640
Mailing Address - Country:US
Mailing Address - Phone:808-469-0300
Mailing Address - Fax:808-213-6704
Practice Address - Street 1:47-435 HUI NENE ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4640
Practice Address - Country:US
Practice Address - Phone:808-469-0300
Practice Address - Fax:808-452-1976
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2023-04-17
Deactivation Date:2019-06-24
Deactivation Code:
Reactivation Date:2019-07-10
Provider Licenses
StateLicense IDTaxonomies
HIAPRN2122363LA2100X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health