Provider Demographics
NPI:1528283801
Name:TESORO DANG, RENEE LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LYNN
Last Name:TESORO DANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-192 MOHAI PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1221
Mailing Address - Country:US
Mailing Address - Phone:808-754-3043
Mailing Address - Fax:
Practice Address - Street 1:86-260 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3128
Practice Address - Country:US
Practice Address - Phone:808-697-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000258426OtherHMSA PROVIDER NUMBER
HI8670783OtherUHA PIN NUMBER
HI57802301OtherALOHA CARE PROVIDER NUMBE
HI57802301OtherALOHA CARE PROVIDER NUMBE
HI8670783OtherUHA PIN NUMBER
HIS79690Medicare UPIN