1841608643 NPI number — MRS. JAMIE JUSTINE MILTENBERGER CRNA

Table of content: MRS. JAMIE JUSTINE MILTENBERGER CRNA (NPI 1841608643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841608643 NPI number — MRS. JAMIE JUSTINE MILTENBERGER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILTENBERGER
Provider First Name:
JAMIE
Provider Middle Name:
JUSTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILEY
Provider Other First Name:
JAMIE
Provider Other Middle Name:
JUSTINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841608643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44-361 NILU ST APT 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANEOHE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96744-2654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-572-6559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3288 MOANALUA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96819-1469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-432-8900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2014

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: 367500000X , with the licence number:  9287023 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RN9287023 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: APRN-2247 . This is a "APRN LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: ARNP9287023 . This is a "ARNP LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: LNP0024174595 . This is a "LNP LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: RN-859964 . This is a "RN LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: RN0001270721 . This is a "RN LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 116351500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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