Individual
MACRINA U VICERRA-JAENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
91-896 MAKULE RD, SUITE 102, EWA BEACH, HI 96706-2526
(808) 689-4414
(808) 689-7115
Mailing address
91-896 MAKULE RD, SUITE 102, EWA BEACH, HI 96706-2526
(808) 689-4414
(808) 689-7115
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN 455
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H54601
MEDICARE PROVIDER NUMBER
HI
01
—
H54603
MEDICARE PROVIDER NUMBER
HI
Enumeration date
05/18/2006
Last updated
08/26/2008
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