Provider Demographics
NPI:1841809555
Name:TIERRA, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TIERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S KING ST STE 214
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2008
Mailing Address - Country:US
Mailing Address - Phone:808-754-7870
Mailing Address - Fax:808-900-8481
Practice Address - Street 1:1350 S KING ST STE 214
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2008
Practice Address - Country:US
Practice Address - Phone:808-900-8480
Practice Address - Fax:808-900-8481
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHCA-60376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker