Provider Demographics
NPI:1710638416
Name:SHIFFLETT, NICOLE (LSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SHIFFLETT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:FARQUHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6811 ENGANO LN
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-3041
Mailing Address - Country:US
Mailing Address - Phone:405-812-9159
Mailing Address - Fax:
Practice Address - Street 1:6811 ENGANO LN
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-3041
Practice Address - Country:US
Practice Address - Phone:405-812-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
HI2994104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator