Provider Demographics
NPI:1790391837
Name:ADVANCE PRACTICE INC
Entity Type:Organization
Organization Name:ADVANCE PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRACHER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:808-664-1104
Mailing Address - Street 1:875 WAIMANU ST STE 600
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5267
Mailing Address - Country:US
Mailing Address - Phone:808-664-1104
Mailing Address - Fax:
Practice Address - Street 1:875 WAIMANU ST STE 600
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5267
Practice Address - Country:US
Practice Address - Phone:808-664-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty