Provider Demographics
NPI:1699780411
Name:ST. FRANCIS LIVER CENTER
Entity type:Organization
Organization Name:ST. FRANCIS LIVER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MEI
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:808-547-6537
Mailing Address - Street 1:2228 LILIHA ST STE 306
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1653
Mailing Address - Country:US
Mailing Address - Phone:808-547-6537
Mailing Address - Fax:808-533-1324
Practice Address - Street 1:2228 LILIHA ST STE 306
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1653
Practice Address - Country:US
Practice Address - Phone:808-547-6537
Practice Address - Fax:808-533-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI537269-01Medicaid
HIH55109Medicare ID - Type Unspecified
HIP80095Medicare UPIN