Provider Demographics
NPI:1730553793
Name:MADAYAG, WILNA (CNA)
Entity type:Individual
Prefix:
First Name:WILNA
Middle Name:
Last Name:MADAYAG
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 1:94-110 KAUPU PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3800
Mailing Address - Country:US
Mailing Address - Phone:808-784-9204
Mailing Address - Fax:808-888-7486
Practice Address - Street 1:94-110 KAUPU PL
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3800
Practice Address - Country:US
Practice Address - Phone:808-784-9204
Practice Address - Fax:808-888-7486
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home