MEDICARE: JACQUELINE F WERNER

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN-41860	HI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN-3044	HI

General Provider Information

NPI Number	:	1720624448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE F WERNER

Provider Business Mailing Address
First Line	:	45-1123 KAMEHAMEHA HWY STE D
Second Line	:
City	:	KANEOHE
State	:	HI
Zip	:	96744-3252
Country	:	US
Telephone Number	:	808-744-0222
Fax Number	:	808-490-0349

Provider Business Practice Location Address
First Line	:	45-1123 KAMEHAMEHA HWY STE D
Second Line	:
City	:	KANEOHE
State	:	HI
Zip	:	96744-3252
Country	:	US
Telephone Number	:	808-744-0222
Fax Number	:	808-490-0349

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

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	05/12/2026

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