Healthcare Provider Details

I. General information

NPI: 1578543286
Provider Name (Legal Business Name): JENNIE MARIE SEKIYA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S KING ST
HONOLULU HI
96813-3097
US

IV. Provider business mailing address

55 MERCHANT ST FL 22
HONOLULU HI
96813-4333
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704225909
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-3531
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: