Provider Demographics
NPI:1710862883
Name:JENSEN-MADISON, MAREKA KELLY (BCNP)
Entity type:Individual
Prefix:MRS
First Name:MAREKA
Middle Name:KELLY
Last Name:JENSEN-MADISON
Suffix:
Gender:F
Credentials:BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44-137 A KAUINOHEA PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2571
Mailing Address - Country:US
Mailing Address - Phone:808-900-1507
Mailing Address - Fax:
Practice Address - Street 1:44-137 KAUINOHEA PL APT A
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2571
Practice Address - Country:US
Practice Address - Phone:808-900-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist