Healthcare Provider Details

I. General information

NPI: 1104155183
Provider Name (Legal Business Name): JESSICA HAMMONDS DEERY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 MOANALUA RD
HONOLULU HI
96819-1469
US

IV. Provider business mailing address

1946 YOUNG ST SUITE 320
HONOLULU HI
96826-2169
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-0000
  • Fax:
Mailing address:
  • Phone: 808-973-7320
  • Fax: 808-973-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-66462
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: