Individual
BRENDA A L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
45-602 KAMEHAMEHA HWY, KANEOHE, HI 96744-2017
(808) 432-3800
Mailing address
45-602 KAMEHAMEHA HWY, KANEOHE, HI 96744-2017
(808) 432-3800
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN-89
HI
363LF0000X
Family Nurse Practitioner
APRN-89
HI
367A00000X
Advanced Practice Midwife
Primary
APRN-89
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A0229342
HMSA BILLING NUMBER
HI
05
—
54134302
—
HI
05
—
61565108
—
HI
Enumeration date
01/25/2007
Last updated
08/21/2009
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