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General NPI Number Information
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NPI Number | 1194233668
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Entity Type | Organization
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Legal Business Name | JOLYN A ROSE, L.AC, LLC
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 4544 KUKUI ST
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City | KAPAA
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State | HI
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Zip | 96746-1716
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Country | US
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Telephone | 808-639-3070
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 441
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City | KILAUEA
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State | HI
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Zip | 96754-0441
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | JOLYN ROSE
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Credential |
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Telephone | 808-639-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 998
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License Number State | HI
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