1982739264 NPI number — JANICE MARGARET BRENCICK APRN-BC, PHD

Table of content: JANICE MARGARET BRENCICK APRN-BC, PHD (NPI 1982739264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982739264 NPI number — JANICE MARGARET BRENCICK APRN-BC, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENCICK
Provider First Name:
JANICE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HECEMOVICH
Provider Other First Name:
JANICE
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN CS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982739264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAMUELA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96743-7038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-885-9393
Provider Business Mailing Address Fax Number:
808-885-9379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645308 PUU NANI DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-7038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-885-9393
Provider Business Practice Location Address Fax Number:
808-885-9379
Provider Enumeration Date:
02/23/2007

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: 163WP0808X , with the licence number:  APRN-399 , 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: 50186801 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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