Individual
SHANE D. WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
55 MAUI LANI PKWY, WAILUKU, HI 96793-2416
(808) 243-6050
Mailing address
55 MAUI LANI PKWY, WAILUKU, HI 96793-2416
(808) 243-6050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
AMD-913
HI
363A00000X
Physician Assistant
PA10005374
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
231200
LABOR & INDUST
WA
05
—
8505448
—
WA
01
—
PA10005374
LICENSE
WA
Enumeration date
02/13/2008
Last updated
05/17/2021
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