Provider Demographics
NPI:1780330738
Name:JONES, CASSIDY LYNNE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:LYNNE
Last Name:JONES
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-559 KEAAHALA RD APT G
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-7312
Mailing Address - Country:US
Mailing Address - Phone:808-753-2788
Mailing Address - Fax:
Practice Address - Street 1:45-559 KEAAHALA RD APT G
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-7312
Practice Address - Country:US
Practice Address - Phone:808-753-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI84000163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE