Provider Demographics
NPI:1053747923
Name:SHIMOTSU, MARISA ANN KIMIKO HAYASHI (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:ANN KIMIKO HAYASHI
Last Name:SHIMOTSU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-446 LOLII ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5910
Mailing Address - Country:US
Mailing Address - Phone:808-277-1040
Mailing Address - Fax:
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3097
Practice Address - Country:US
Practice Address - Phone:808-532-3159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA757305163W00000X
HI74443163W00000X
CA23491363LF0000X
HI1659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse