Provider Demographics
NPI:1558606756
Name:PETERNELL, BRONWEN STEPHANIE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BRONWEN
Middle Name:STEPHANIE
Last Name:PETERNELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1325
Mailing Address - Country:US
Mailing Address - Phone:808-495-7681
Mailing Address - Fax:949-655-5945
Practice Address - Street 1:1135 MAKAWAO AVE STE 202
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7403
Practice Address - Country:US
Practice Address - Phone:808-495-7681
Practice Address - Fax:949-655-5945
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337619363LF0000X
CA21431363LF0000X
HI3455-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily