Healthcare Provider Details

I. General information

NPI: 1598219586
Provider Name (Legal Business Name): VANESSA HUNT-JANSEN CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5549 KAWAIKUI ST
HONOLULU HI
96821-2018
US

IV. Provider business mailing address

5549 KAWAIKUI ST
HONOLULU HI
96821-2018
US

V. Phone/Fax

Practice location:
  • Phone: 808-754-6122
  • Fax:
Mailing address:
  • Phone: 808-754-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number10068R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: