Provider Demographics
NPI:1659937878
Name:TYRRELL, SOONJA (APRN-RX, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SOONJA
Middle Name:
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:APRN-RX, PMHNP-BC
Other - Prefix:
Other - First Name:SOON-JA
Other - Middle Name:
Other - Last Name:TYRRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-RX, PMHNP-BC
Mailing Address - Street 1:PO BOX 60599
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-7599
Mailing Address - Country:US
Mailing Address - Phone:808-664-1104
Mailing Address - Fax:866-592-3149
Practice Address - Street 1:928 NUUANU AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5193
Practice Address - Country:US
Practice Address - Phone:808-664-1104
Practice Address - Fax:866-592-3149
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-34892084P0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIRN01263OtherCERTIFICATE OF REGISTRATION FOR CONTROLLED SUBSTANCES/NARCOTICS ENFORCEMENT DIV.