Provider Demographics
NPI:1982318770
Name:ANDRADE, JENNIFER MARIE (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3-3420 KUHIO HWY
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1042
Mailing Address - Country:US
Mailing Address - Phone:808-245-1504
Mailing Address - Fax:808-246-1363
Practice Address - Street 1:3-3420 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1042
Practice Address - Country:US
Practice Address - Phone:808-245-1504
Practice Address - Fax:808-246-1363
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3488-0363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care