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General NPI Number Information
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NPI Number | 1245463116
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Entity Type | Individual
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Provider Name | MICHELLE L SHANKS ARNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 1005 KEOLU DR STE A
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City | KAILUA
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State | HI
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Zip | 96734-3873
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Country | US
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Telephone | 808-727-1715
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Fax |
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Provider Business Mailing Address
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Address Line | 84-740 KILI DR APT 427
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City | WAIANAE
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State | HI
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Zip | 96792-1512
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Country | US
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Telephone | 808-825-0190
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 6147
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1452
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 71639
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License Number State | HI
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