Provider Demographics
NPI:1417689043
Name:LARIEGO, JESSICA NALANI JICHA (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NALANI JICHA
Last Name:LARIEGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:NALANI
Other - Last Name:JICHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:94-970 LUMIAUAU ST APT F103
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4828
Mailing Address - Country:US
Mailing Address - Phone:808-216-2591
Mailing Address - Fax:
Practice Address - Street 1:700 BISHOP ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4124
Practice Address - Country:US
Practice Address - Phone:808-356-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-91272163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics