Healthcare Provider Details

I. General information

NPI: 1780438317
Provider Name (Legal Business Name): DAWN ELIZABETH CARLOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

2818 KOLOWALU ST
HONOLULU HI
96822-1830
US

V. Phone/Fax

Practice location:
  • Phone: 808-566-8384
  • Fax:
Mailing address:
  • Phone: 845-321-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-77702
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: