Healthcare Provider Details

I. General information

NPI: 1003681974
Provider Name (Legal Business Name): JENNY NAKANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4819 KILAUEA AVE STE 7
HONOLULU HI
96816-5712
US

IV. Provider business mailing address

98-1991 KAAHUMANU ST APT E
AIEA HI
96701-1892
US

V. Phone/Fax

Practice location:
  • Phone: 808-808-1324
  • Fax:
Mailing address:
  • Phone: 808-218-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-4060
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: