Provider Demographics
NPI:1104374669
Name:ALCON, ROSALIE SANTOS
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:SANTOS
Last Name:ALCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 W PAPA AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2744
Mailing Address - Country:US
Mailing Address - Phone:808-298-7041
Mailing Address - Fax:808-868-4500
Practice Address - Street 1:161 W PAPA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2744
Practice Address - Country:US
Practice Address - Phone:808-298-7041
Practice Address - Fax:808-868-4500
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI030102592164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse