Provider Demographics
NPI:1073747622
Name:BARTCH, JESSIE
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:BARTCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 KALAKAUA AVE
Mailing Address - Street 2:707
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3766
Mailing Address - Country:US
Mailing Address - Phone:808-282-2697
Mailing Address - Fax:
Practice Address - Street 1:1750 KALAKAUA AVE
Practice Address - Street 2:707
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3766
Practice Address - Country:US
Practice Address - Phone:808-282-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI59398163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health