Provider Demographics
NPI:1245463116
Name:SHANKS, MICHELLE L (ARNP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:SHANKS
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84-740 KILI DR APT 427
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-1512
Mailing Address - Country:US
Mailing Address - Phone:808-825-0190
Mailing Address - Fax:
Practice Address - Street 1:1005 KEOLU DR STE A
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3873
Practice Address - Country:US
Practice Address - Phone:808-727-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6147363LA2200X
HI1452363LA2200X
HI71639163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse