Healthcare Provider Details

I. General information

NPI: 1609162981
Provider Name (Legal Business Name): CINDY A JEAN-ROONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5751 KUAKINI HWY STE 101A
KAILUA KONA HI
96740-1705
US

IV. Provider business mailing address

75-5751 KUAKINI HWY STE 203
KAILUA KONA HI
96740-1753
US

V. Phone/Fax

Practice location:
  • Phone: 808-326-5629
  • Fax: 808-329-5057
Mailing address:
  • Phone: 808-326-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4080
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN 1589
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: