Provider Demographics
NPI:1518225267
Name:THEINE, JEANMARIE ROSE
Entity Type:Individual
Prefix:MS
First Name:JEANMARIE
Middle Name:ROSE
Last Name:THEINE
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 1:33 ULUWAI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1920
Mailing Address - Country:US
Mailing Address - Phone:909-933-2442
Mailing Address - Fax:
Practice Address - Street 1:460 KILAUEA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3084
Practice Address - Country:US
Practice Address - Phone:808-315-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator