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General NPI Number Information
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NPI Number | 1255136826
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Entity Type | Individual
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Provider Name | SHAYNE NICOLE OPAL PHILLIPS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 5520 KA HAKU RD
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City | PRINCEVILLE
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State | HI
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Zip | 96722-5214
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Country | US
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Telephone | 808-975-6975
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Fax |
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Provider Business Mailing Address
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Address Line | 4771 PEPELANI LOOP APT 522
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City | PRINCEVILLE
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State | HI
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Zip | 96722-5547
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Country | US
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Telephone | 760-937-2623
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-4975
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License Number State | HI
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