Healthcare Provider Details

I. General information

NPI: 1700305562
Provider Name (Legal Business Name): JILL MARI NAGAFUCHI GREGORY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL M NAGAFUCHI RN

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCBH KANEOHE BAY BRANCH HEALTH CLINIC D ST #3089
KAILUA HI
96734
US

IV. Provider business mailing address

134 E MISTLETOE AVE
SAN ANTONIO TX
78212-3407
US

V. Phone/Fax

Practice location:
  • Phone: 808-257-5041
  • Fax:
Mailing address:
  • Phone: 210-223-1100
  • Fax: 866-208-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN44552
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: