Provider Demographics
NPI:1518231059
Name:BROOKS, MIRELLA VASQUEZ (NP)
Entity Type:Individual
Prefix:DR
First Name:MIRELLA
Middle Name:VASQUEZ
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:98-1005 MOANALUA RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4777
Mailing Address - Country:US
Mailing Address - Phone:808-440-4836
Mailing Address - Fax:808-440-4827
Practice Address - Street 1:98-1005 MOANALUA RD
Practice Address - Street 2:SUITE 420
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4777
Practice Address - Country:US
Practice Address - Phone:808-440-4836
Practice Address - Fax:808-440-4827
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIAPRN253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily