Healthcare Provider Details

I. General information

NPI: 1790083483
Provider Name (Legal Business Name): JANET PUANANI EBLEN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44-5403 WAIKAALULU RD
HONOKAA HI
96727-6965
US

IV. Provider business mailing address

PO BOX 41
PAAUILO HI
96776-0041
US

V. Phone/Fax

Practice location:
  • Phone: 808-499-4311
  • Fax:
Mailing address:
  • Phone: 808-499-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number273
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: