Basic Information
| Provider Information | |||||||||
| NPI: | 1558401141 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBERT | ||||||||
| FirstName: | JEANNE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1946 YOUNG ST | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968262150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089737320 | ||||||||
| FaxNumber: | 8089737325 | ||||||||
| Practice Location | |||||||||
| Address1: | 3-3420 KUHIO HWY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967661042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082451500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | AMD-279 | HI | X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363LF0000X | APRN-764 | HI | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.