Provider Demographics
NPI:1336100049
Name:BRANDMAN, J D WAILUA (APRN PMHCNS/NP-BC)
Entity Type:Individual
Prefix:MR
First Name:J D
Middle Name:WAILUA
Last Name:BRANDMAN
Suffix:
Gender:M
Credentials:APRN PMHCNS/NP-BC
Other - Prefix:MR
Other - First Name:JD WAILUA
Other - Middle Name:
Other - Last Name:BRANDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:615 PIIKOI ST
Mailing Address - Street 2:SUITE 1406
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3116
Mailing Address - Country:US
Mailing Address - Phone:808-593-7703
Mailing Address - Fax:808-593-7703
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:SUITE 1406
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-593-7703
Practice Address - Fax:808-593-7703
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN13363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0217578OtherHMSA/BCBS
HIBF505ZOtherMEDICARE PTAN
HI25092001Medicaid
HI25092001Medicaid
HIP57443Medicare UPIN