Provider Demographics
NPI:1861778805
Name:BRINK WONG, TERESA LOUISE (RN CDE)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LOUISE
Last Name:BRINK WONG
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST STE 540
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1046
Mailing Address - Country:US
Mailing Address - Phone:808-983-8559
Mailing Address - Fax:808-983-8559
Practice Address - Street 1:1319 PUNAHOU ST STE 540
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1046
Practice Address - Country:US
Practice Address - Phone:808-983-8559
Practice Address - Fax:808-983-8559
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN24083163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator