Provider Demographics
NPI:1447445549
Name:GRAHAM, JERE MAPUANA (APRN-BC RX)
Entity type:Individual
Prefix:MS
First Name:JERE
Middle Name:MAPUANA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:APRN-BC RX
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6181 A KAWAIHAU RD.
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2613
Mailing Address - Country:US
Mailing Address - Phone:808-651-6777
Mailing Address - Fax:808-821-1670
Practice Address - Street 1:4520 AKIA RD STE A
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1615
Practice Address - Country:US
Practice Address - Phone:808-651-6779
Practice Address - Fax:808-821-1670
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN257364SP0809X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult