Healthcare Provider Details

I. General information

NPI: 1912433053
Provider Name (Legal Business Name): JACQUELYN HORRELL LM, IBCLC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELYN INGRAM RN, LM, IBCLC

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N KUKUI ST STE 102A
HONOLULU HI
96817-3921
US

IV. Provider business mailing address

149 HAUOLI ST
KAILUA HI
96734
US

V. Phone/Fax

Practice location:
  • Phone: 808-452-1009
  • Fax: 808-452-1469
Mailing address:
  • Phone: 310-945-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN-122907
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW-7
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-122907
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: