Provider Demographics
NPI:1053764472
Name:PARSONS, JEANA (RD)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:
Last Name:PARSONS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HAKALANI PL
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-3108
Mailing Address - Country:US
Mailing Address - Phone:808-283-1250
Mailing Address - Fax:
Practice Address - Street 1:73 HAKALANI PL
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-3108
Practice Address - Country:US
Practice Address - Phone:808-283-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI00961232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered