Provider Demographics
NPI:1124387493
Name:LANDGRAF, SHANNON MARIE NOELANI
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARIE NOELANI
Last Name:LANDGRAF
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 1:460 KILAUEA AVENUE SUITE 101
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3084
Mailing Address - Country:US
Mailing Address - Phone:808-934-9405
Mailing Address - Fax:808-974-9189
Practice Address - Street 1:460 KILAUEA AVENUE SUITE 101
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3084
Practice Address - Country:US
Practice Address - Phone:808-934-9405
Practice Address - Fax:808-974-9189
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator