Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DOS978 | HI |
N | 207Q00000X | Family Doctor | DOS978 | HI |
NPI | 1003870403 |
---|---|
Provider Name | Dr. Roselia Schlichtig Conrad |
First Address | Kailua-Kona, HI 96740 |
Second Address | Kailua-Kona, HI 96740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 16/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F87504 | (02) | HI |