Provider Demographics
NPI:1669988184
Name:CONNELLY, EMMA NATSUMI
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:NATSUMI
Last Name:CONNELLY
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 1:3323 HAYDEN ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-4378
Mailing Address - Country:US
Mailing Address - Phone:949-929-5034
Mailing Address - Fax:
Practice Address - Street 1:3323 HAYDEN ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-4378
Practice Address - Country:US
Practice Address - Phone:949-929-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
99318OtherSTUDENT