Healthcare Provider Details

I. General information

NPI: 1356547897
Provider Name (Legal Business Name): SHAWNA L COOPER LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 KILAUEA AVE STE A
HILO HI
96720-4291
US

IV. Provider business mailing address

PO BOX 563 APT B69
PEPEEKEO HI
96783-0563
US

V. Phone/Fax

Practice location:
  • Phone: 808-780-5771
  • Fax:
Mailing address:
  • Phone: 808-780-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number208061
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: