Jacqueline C Desa-Shishido, LPN
Individual provider Active NPI Licensed Practical Nurse · Pahoa, HI
NPI 1114298569 · NPPES record last updated Jan 17, 2012
Key facts
- NPI
- 1114298569
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 9065 (HI)
- Practice address
- 15-2866 Pahoa Village Rd
BLDG E.
Pahoa, HI 96778-7720 - Phone
- (808) 965-2241
- Fax
- (808) 965-2240
- NPI assigned
- Jan 17, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9065 | HI | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 9065 | HI | Yes |
Addresses
Primary practice location
15-2866 Pahoa Village Rd
BLDG E.
Pahoa, HI 96778-7720
Mailing address
1250 Punchbowl St
RM 256
Honolulu, HI 96813-2416
Phone (808) 590-7320
Other providers in Pahoa, HI
- Christy Ceraso
- Michael Ceraso
- Chadwic Christopher Chapman
- Leslie Colter
- Jacqueline Nicole Deegan
- Elisha Fawn Diedeerich
- Marion Droe
- Christine Kukui Dufrayer
- Courtney Dusschee
- E Malama Kakou Family Practice
All providers in Pahoa, HI · Licensed Practical Nurse in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.