Provider Demographics
NPI:1861786238
Name:AGNO, JULIE AMANDA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:AMANDA
Last Name:AGNO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:AMANDA
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 492578
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-2578
Mailing Address - Country:US
Mailing Address - Phone:808-690-4836
Mailing Address - Fax:
Practice Address - Street 1:891 ULULANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3982
Practice Address - Country:US
Practice Address - Phone:808-930-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-4968363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health