Provider Demographics
NPI:1962055079
Name:SHAFFER, CAROLINE MUNYISI
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MUNYISI
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 UNIVERSITY AVE UNIT NO301
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2403
Mailing Address - Country:US
Mailing Address - Phone:949-310-8331
Mailing Address - Fax:
Practice Address - Street 1:1904 UNIVERSITY AVE UNIT NO301
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2403
Practice Address - Country:US
Practice Address - Phone:949-310-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI88323163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool