Basic Information
| Provider Information | |||||||||
| NPI: | 1891311585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHANNON | ||||||||
| FirstName: | FLANNERY | ||||||||
| MiddleName: | ADAIR | ||||||||
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| Credential: | DNP, APRN-RX, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 839 S BERETANIA ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007690045 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 839 S BERETANIA ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007690045 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2020 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | 88196 | HI | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 363LF0000X | APRN-2991 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.