Provider Demographics
NPI:1497319644
Name:BARDELL, JANAE KRISTIN
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:KRISTIN
Last Name:BARDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KAHELU AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3913
Mailing Address - Country:US
Mailing Address - Phone:808-625-3000
Mailing Address - Fax:
Practice Address - Street 1:100 KAHELU AVE STE 110
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3913
Practice Address - Country:US
Practice Address - Phone:808-625-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician