Healthcare Provider Details

I. General information

NPI: 1417689043
Provider Name (Legal Business Name): JESSICA NALANI JICHA LARIEGO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA NALANI JICHA RN

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BISHOP ST
HONOLULU HI
96813-4124
US

IV. Provider business mailing address

94-970 LUMIAUAU ST APT F103
WAIPAHU HI
96797-4828
US

V. Phone/Fax

Practice location:
  • Phone: 808-356-4357
  • Fax:
Mailing address:
  • Phone: 808-216-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN-91272
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: