Provider Demographics
NPI:1174209787
Name:JITCHAKU, KENDRA S
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:S
Last Name:JITCHAKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 HOOMALU ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3312
Mailing Address - Country:US
Mailing Address - Phone:808-345-7995
Mailing Address - Fax:
Practice Address - Street 1:238 HOOMALU ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3312
Practice Address - Country:US
Practice Address - Phone:808-345-7995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI56236163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant