Provider Demographics
NPI:1609958149
Name:DELACOURT, JANINE KATINS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:KATINS
Last Name:DELACOURT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JANINE
Other - Middle Name:
Other - Last Name:KATINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1380 LUSITANA STREET
Mailing Address - Street 2:SUITE 1012
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2461
Mailing Address - Country:US
Mailing Address - Phone:808-546-5000
Mailing Address - Fax:808-523-1992
Practice Address - Street 1:1380 LUSITANA STREET
Practice Address - Street 2:SUITE 1012
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2461
Practice Address - Country:US
Practice Address - Phone:808-546-5000
Practice Address - Fax:808-523-1992
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-370363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA180577812BMedicaid
GAQ72662Medicare UPIN
GA97WCJLKMedicare ID - Type Unspecified