Provider Demographics
NPI:1356547897
Name:COOPER, SHAWNA L (LVN)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:LVN
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 563
Mailing Address - Street 2:APT B69
Mailing Address - City:PEPEEKEO
Mailing Address - State:HI
Mailing Address - Zip Code:96783-0563
Mailing Address - Country:US
Mailing Address - Phone:808-780-5771
Mailing Address - Fax:
Practice Address - Street 1:1045 KILAUEA AVE STE A
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4291
Practice Address - Country:US
Practice Address - Phone:808-780-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208061164X00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No164X00000XNursing Service ProvidersLicensed Vocational Nurse