Provider Demographics
NPI:1932430626
Name:JARVIS, SERENA D (LMT)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:D
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74-5124 PALIHIOLO PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9635
Mailing Address - Country:US
Mailing Address - Phone:808-443-9910
Mailing Address - Fax:
Practice Address - Street 1:75-5995 KUAKINI HWY STE 602
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2124
Practice Address - Country:US
Practice Address - Phone:808-443-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist