Provider Demographics
NPI:1720831167
Name:CORTES, JEREMIAH JAY (RN)
Entity Type:Individual
Prefix:
First Name:JEREMIAH JAY
Middle Name:
Last Name:CORTES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:JEREMIAH
Other - Middle Name:
Other - Last Name:CORTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1196
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-8196
Mailing Address - Country:US
Mailing Address - Phone:808-454-1411
Mailing Address - Fax:808-454-0659
Practice Address - Street 1:2501 WAIMANO HOME RD
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1478
Practice Address - Country:US
Practice Address - Phone:808-454-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-66677163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse