Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN1232 | HI |
NPI | 1003147687 |
---|---|
Provider Name | Jessica Jung Ackerman |
First Address | Honolulu, HI 96825-2732 |
Second Address | Honolulu, HI 96815-6612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2010 |
Last Update Date | 21/01/2010 |