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General NPI Number Information
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NPI Number | 1730797424
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Entity Type | Individual
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Provider Name | ELVIE ROSE BISARRA
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Gender | Female
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Dates
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Enumeration Date | 07/19/2020
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 2970 KELE ST STE 110
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City | LIHUE
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State | HI
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Zip | 96766-1822
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Country | US
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Telephone | 808-246-4898
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50977
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City | ELEELE
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State | HI
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Zip | 96705-0977
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | HI
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