Doctor Name: | MRS. JACQUELINE YVONNE CHACON |
NPI Number: | 1023376779 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ANP |
License Number: | 1370 |
Business Practice Address: | 91-896 Makule Rd Suite 102 Ewa Beach, HI - 967062543 |
Business Phone Number: | 8086894414 |
Business Fax Number: | 8086897115 |
Mailing Address: | 91-896 Makule Rd, Suite 102 EWA BEACH |
State: | HI |
Postal Code: | 967062543 |
Phone Number: | 8086894414 |
Fax Number: | 8086897115 |
NPI Enumeration Date: | 05/01/2012 |
NPI Last Update Date: | 07/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1370 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |