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NPI Code Detail

MEDICARE: OLIVIA DENISE CONOVER

MEDICARE: OLIVIA DENISE CONOVER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramHI

General Provider Information

NPI Number : 1770005563
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA DENISE CONOVER
Provider Business Mailing Address
First Line : 4104 ROUND TOP DR
Second Line :
City : HONOLULU
State : HI
Zip : 96822-5020
Country : US
Telephone Number : 609-289-0857
Fax Number :
Provider Business Practice Location Address
First Line : 2444 DOLE ST
Second Line :
City : HONOLULU
State : HI
Zip : 96822-2399
Country : US
Telephone Number : 808-956-9559
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2017
Last Update Date : 03/15/2022

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Directions to “ OLIVIA DENISE CONOVER ” Practice Location

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