=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003147687
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA JUNG ACKERMAN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2010
-----------------------------------------------------
Last Update Date | 01/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 277 OHUA AVE
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96815-6612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-922-4787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7219 OPAEKAA ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96825-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-282-2084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN1232
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------