Provider Demographics
NPI:1275711731
Name:PELIKAN, JONATHAN N (PA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:N
Last Name:PELIKAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 WAIANAE AVE
Mailing Address - Street 2:BLDG 677
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96876-5004
Mailing Address - Country:US
Mailing Address - Phone:808-433-8233
Mailing Address - Fax:808-433-8217
Practice Address - Street 1:683 WAIANAE AVE
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96876-5004
Practice Address - Country:US
Practice Address - Phone:808-433-8233
Practice Address - Fax:808-433-8217
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZPA9104957363A00000X
FLPA9104957363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant