Provider Demographics
NPI:1053072066
Name:PADDOCK, JENNETTE (CD (DONA))
Entity Type:Individual
Prefix:
First Name:JENNETTE
Middle Name:
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:CD (DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55-422 IOSEPA ST
Mailing Address - Street 2:
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762-1105
Mailing Address - Country:US
Mailing Address - Phone:808-469-9764
Mailing Address - Fax:
Practice Address - Street 1:55-422 IOSEPA ST
Practice Address - Street 2:
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762-1105
Practice Address - Country:US
Practice Address - Phone:808-469-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula