Provider Demographics
NPI:1700305562
Name:NAGAFUCHI GREGORY, JILL MARI (RN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARI
Last Name:NAGAFUCHI GREGORY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:NAGAFUCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:134 E MISTLETOE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3407
Mailing Address - Country:US
Mailing Address - Phone:210-223-1100
Mailing Address - Fax:866-208-9875
Practice Address - Street 1:MCBH KANEOHE BAY BRANCH HEALTH CLINIC
Practice Address - Street 2:D ST #3089
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-257-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN44552163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care