Provider Demographics
NPI:1841609971
Name:NORMAN, SHELLIE R (APRN)
Entity Type:Individual
Prefix:DR
First Name:SHELLIE
Middle Name:R
Last Name:NORMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2279
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-2279
Mailing Address - Country:US
Mailing Address - Phone:808-323-2608
Mailing Address - Fax:808-885-9793
Practice Address - Street 1:75-5995 KUAKINI HWY STE 443&445
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-323-2608
Practice Address - Fax:808-885-9793
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1841363LF0000X
IDNP-1468A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAPRN-1841OtherAPRN LICENSE