Provider Demographics
NPI:1922208685
Name:ROSS, REBECCA LEE (RN, PHD, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LEE
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN, PHD, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PIIKOI ST STE 2002
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3142
Mailing Address - Country:US
Mailing Address - Phone:808-491-5533
Mailing Address - Fax:888-391-1445
Practice Address - Street 1:615 PIIKOI ST STE 2002
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3142
Practice Address - Country:US
Practice Address - Phone:808-491-5533
Practice Address - Fax:888-391-1445
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4299363LP0808X
HIAPRN-1816363LP0808X
OR089003200N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR105724Medicaid
AZ735373Medicaid
ORR106538Medicare UPIN