Provider Demographics
NPI:1427221100
Name:JENNISON, DEBORAH (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:JENNISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:LAWAI
Mailing Address - State:HI
Mailing Address - Zip Code:96765-0104
Mailing Address - Country:US
Mailing Address - Phone:808-639-5023
Mailing Address - Fax:
Practice Address - Street 1:2-2488 KAUMUALII HWY
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8306
Practice Address - Country:US
Practice Address - Phone:808-332-5580
Practice Address - Fax:808-332-5581
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-6671171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor