Provider Demographics
NPI:1891136131
Name:ADVENT HEALTHCARE & WELLNESS INC.
Entity Type:Organization
Organization Name:ADVENT HEALTHCARE & WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:PUEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-359-1641
Mailing Address - Street 1:2964 IOLANI ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8531
Mailing Address - Country:US
Mailing Address - Phone:808-359-1641
Mailing Address - Fax:
Practice Address - Street 1:2964 IOLANI ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8531
Practice Address - Country:US
Practice Address - Phone:808-359-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1420363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty