Provider Demographics
NPI:1467040568
Name:PONCIANO, JENNY DOMINGO (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:DOMINGO
Last Name:PONCIANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1132 LUMIAUAU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3922
Mailing Address - Country:US
Mailing Address - Phone:808-636-1274
Mailing Address - Fax:808-082-6041
Practice Address - Street 1:94-1132 LUMIAUAU ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3922
Practice Address - Country:US
Practice Address - Phone:808-636-1274
Practice Address - Fax:808-082-6041
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-200047253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency