Provider Demographics
NPI:1295881092
Name:WOMACK, SHELLEY A (NP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:WOMACK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:A
Other - Last Name:HEBBLETHWAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 MAUILANI PKWY
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2416
Mailing Address - Country:US
Mailing Address - Phone:808-871-9240
Mailing Address - Fax:808-871-9262
Practice Address - Street 1:472 KAULANA ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2050
Practice Address - Country:US
Practice Address - Phone:808-871-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-129363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000224550OtherHMSA BILLING NUMBER
HI55018801Medicaid
HI0000224550OtherHMSA BILLING NUMBER
HIH55015Medicare PIN