Individual
GRAYDEN J SHULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3288 MOANALUA RD, HONOLULU, HI 96819-1469
(808) 432-0000
Mailing address
2425 M 28 E, MARQUETTE, MI 49855-9532
(906) 343-6502
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704230718
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104782094
—
MI
01
—
44343100
WISC MEDICAID
WI
01
—
GS230718
BLUESHIELD PIN
MI
Enumeration date
11/15/2005
Last updated
04/19/2021
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