Provider Demographics
NPI:1912433053
Name:HORRELL, JACQUELYN (LM, IBCLC, RN)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:HORRELL
Suffix:
Gender:F
Credentials:LM, IBCLC, RN
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, LM, IBCLC
Mailing Address - Street 1:149 HAUOLI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:310-945-7290
Mailing Address - Fax:
Practice Address - Street 1:245 N KUKUI ST STE 102A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3921
Practice Address - Country:US
Practice Address - Phone:808-452-1009
Practice Address - Fax:808-452-1469
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-122907163WL0100X, 163W00000X
HIMW-7176B00000X
CA381176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse