1346372489 NPI number — MRS. JADINE L. BROWN MPT

Table of content: MRS. JADINE L. BROWN MPT (NPI 1346372489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346372489 NPI number — MRS. JADINE L. BROWN MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
JADINE
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JARIT
Provider Other First Name:
JADINE
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346372489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
239 UPPER KIMO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KULA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96790-8052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-344-1740
Provider Business Mailing Address Fax Number:
808-244-3411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 S MARKET ST
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-244-3440
Provider Business Practice Location Address Fax Number:
808-244-3411
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2028 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23701-6 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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