Provider Demographics
NPI:1144827148
Name:BADUA, NINA MYRA (CNA)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MYRA
Last Name:BADUA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1307 MALIKO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1809
Mailing Address - Country:US
Mailing Address - Phone:808-729-6560
Mailing Address - Fax:808-681-3383
Practice Address - Street 1:91-1307 MALIKO ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1809
Practice Address - Country:US
Practice Address - Phone:808-729-6560
Practice Address - Fax:808-681-3383
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-190044311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1-190044OtherDOH OHCA
HI2027619OtherOHANA WELLCARE