Provider Demographics
NPI:1437357969
Name:EADS, JENNY QUYNH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:QUYNH
Last Name:EADS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:QUYNH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:74-517 HONOKOHAU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2715
Mailing Address - Country:US
Mailing Address - Phone:808-334-4400
Mailing Address - Fax:
Practice Address - Street 1:74-517 HONOKOHAU ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2715
Practice Address - Country:US
Practice Address - Phone:808-334-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1361363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF003ZMedicare PIN