Individual
DEBORAH JENNISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2-2488 KAUMUALII HWY, KALAHEO, HI 96741-8306
(808) 332-5580
(808) 332-5581
Mailing address
PO BOX 104, LAWAI, HI 96765-0104
(808) 639-5023
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MAT-6671
HI
Other
Enumeration date
04/02/2008
Last updated
04/02/2008
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