Provider Demographics
NPI:1255136826
Name:PHILLIPS, SHAYNE NICOLE OPAL (FNP-C)
Entity type:Individual
Prefix:MS
First Name:SHAYNE
Middle Name:NICOLE OPAL
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4771 PEPELANI LOOP APT 522
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:HI
Mailing Address - Zip Code:96722-5547
Mailing Address - Country:US
Mailing Address - Phone:760-937-2623
Mailing Address - Fax:
Practice Address - Street 1:5520 KA HAKU RD
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:HI
Practice Address - Zip Code:96722-5214
Practice Address - Country:US
Practice Address - Phone:808-975-6975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-4975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily