Provider Demographics
NPI:1225681208
Name:BELASKI, JESSICA
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:BELASKI
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 1:710 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2119
Mailing Address - Country:US
Mailing Address - Phone:808-536-1015
Mailing Address - Fax:
Practice Address - Street 1:NAPUAKEA WAIVER PROGRAM SERVICE CENTER
Practice Address - Street 2:92-461 MAKAKILO DRIVE
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-678-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker