Healthcare Provider Details

I. General information

NPI: 1205328101
Provider Name (Legal Business Name): JAMIE LEIGH DEUCHLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-1032 MAMALAHOA HWY
KAMUELA HI
96743-8441
US

IV. Provider business mailing address

PO BOX 6149
KAMUELA HI
96743-6149
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-1878
  • Fax: 808-887-1857
Mailing address:
  • Phone: 808-885-1878
  • Fax: 808-887-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-3260
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00826600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: