Individual
JACQUELINE C DESA-SHISHIDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
15-2866 PAHOA VILLAGE RD, BLDG E., PAHOA, HI 96778-7720
(808) 965-2241
(808) 965-2240
Mailing address
1250 PUNCHBOWL ST, RM 256, HONOLULU, HI 96813-2416
(808) 590-7320
(808) 586-4675
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
9065
HI
Other
Enumeration date
01/17/2012
Last updated
01/17/2012
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