Provider Demographics
NPI:1962652149
Name:BABAUTA, JADEAN MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:JADEAN
Middle Name:MICHELLE
Last Name:BABAUTA
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 1:1301 PUNCHBOWL ST
Mailing Address - Street 2:FAMILY TREATMENT CENTER
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2402
Mailing Address - Country:US
Mailing Address - Phone:808-547-4221
Mailing Address - Fax:808-537-7896
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:FAMILY TREATMENT CENTER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-547-4221
Practice Address - Fax:808-537-7896
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN39285163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent