Provider Demographics
NPI:1487032918
Name:OETKEN LEWIS, SHANA
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:OETKEN LEWIS
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 1:1110 UNIVERSITY AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1540
Mailing Address - Country:US
Mailing Address - Phone:808-206-8210
Mailing Address - Fax:844-680-3908
Practice Address - Street 1:1110 UNIVERSITY AVE
Practice Address - Street 2:STE 302
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1540
Practice Address - Country:US
Practice Address - Phone:808-206-8210
Practice Address - Fax:844-680-3908
Is Sole Proprietor?:No
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist