MEDICARE: JANIECE JENKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN81423	HI

General Provider Information

NPI Number	:	1134664469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIECE JENKINS

Provider Business Mailing Address
First Line	:	3669 KAWELOLANI PL
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-3303
Country	:	US
Telephone Number	:	850-529-1970
Fax Number	:

Provider Business Practice Location Address
First Line	:	3669 KAWELOLANI PL
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-3303
Country	:	US
Telephone Number	:	850-529-1970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	12/22/2016

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Directions to “ JANIECE JENKINS ” Practice Location

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