Provider Demographics
NPI:1568672038
Name:IMADA, TERRI LEE (APRN, ANP-C)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LEE
Last Name:IMADA
Suffix:
Gender:F
Credentials:APRN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 S BERETANIA ST
Mailing Address - Street 2:KAPIOLANI BREAST CENTER
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826
Mailing Address - Country:US
Mailing Address - Phone:808-973-3152
Mailing Address - Fax:808-973-4762
Practice Address - Street 1:1907 S BERETANIA ST
Practice Address - Street 2:KAPIOLANI BREAST CENTER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826
Practice Address - Country:US
Practice Address - Phone:808-973-3152
Practice Address - Fax:808-973-4762
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-345363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health