Provider Demographics
NPI:1982739264
Name:BRENCICK, JANICE MARGARET (APRN-BC, PHD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARGARET
Last Name:BRENCICK
Suffix:
Gender:F
Credentials:APRN-BC, PHD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:MARGARET
Other - Last Name:HECEMOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN CS
Mailing Address - Street 1:PO BOX 7038
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7038
Mailing Address - Country:US
Mailing Address - Phone:808-885-9393
Mailing Address - Fax:808-885-9379
Practice Address - Street 1:645308 PUU NANI DR.
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7038
Practice Address - Country:US
Practice Address - Phone:808-885-9393
Practice Address - Fax:808-885-9379
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-399163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50186801Medicaid
HI50186801Medicaid