Basic Information
| Provider Information | |||||||||
| NPI: | 1639640683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORSI | ||||||||
| FirstName: | JENNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 98-1079 MOANALUA RD | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014713 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 98-1079 MOANALUA RD | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084866000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2018 | ||||||||
| LastUpdateDate: | 12/16/2018 | ||||||||
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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 | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.