Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY1298 | HI |
Y | 103TC0700X | Clinical Psychologist | PSY1298 | HI |
N | 103TH0004X | Health Psychologist | PSY1298 | HI |
NPI | 1053680843 |
---|---|
Provider Name | Dr. Joann Lee Shimabukuro |
First Address | Luke Afb, AZ 85309-1529 |
Second Address | Luke Afb, AZ 85309-1529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2011 |
Last Update Date | 03/12/2012 |