Provider Demographics
NPI:1023454378
Name:MEISTER, JACKIE L (CNM)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:L
Last Name:MEISTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1228
Mailing Address - Country:US
Mailing Address - Phone:808-934-4000
Mailing Address - Fax:
Practice Address - Street 1:1292 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1228
Practice Address - Country:US
Practice Address - Phone:808-934-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM652367A00000X
NVAPRN001975367A00000X
HIAPRN-2235367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM803537Medicaid
NV1023454378Medicaid
NV1023454378Medicaid