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General NPI Number Information
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NPI Number | 1497226054
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Entity Type | Organization
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Legal Business Name | ISLAND DERMATOLOGY LLC
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 75-5995 KUAKINI HWY STE 443&445
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City | KAILUA KONA
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State | HI
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Zip | 96740-2144
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Country | US
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Telephone | 808-323-2608
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Fax | 808-885-9793
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Provider Business Mailing Address
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Address Line | PO BOX 2279
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City | KAILUA KONA
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State | HI
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Zip | 96745-2279
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Country | US
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Telephone | 808-323-2608
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Fax | 808-885-9793
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SHELLIE R NORMAN
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Credential | APRN
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Telephone | 208-640-3504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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