Individual
JACKIELYN BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
91-843 HANAKAHI ST, EWA BEACH, HI 96706
(808) 256-4379
Mailing address
91-843 HANAKAHI ST, EWA BEACH, HI 96706-2861
(808) 256-4379
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
—
—
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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