Provider Demographics
NPI:1568991115
Name:BATINO, WILMA GARDUQUE
Entity Type:Individual
Prefix:MISS
First Name:WILMA
Middle Name:GARDUQUE
Last Name:BATINO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WILMA
Other - Middle Name:GARDUQE
Other - Last Name:ANCHETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 KAULANA ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1950
Mailing Address - Country:US
Mailing Address - Phone:808-385-0520
Mailing Address - Fax:
Practice Address - Street 1:121 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2528
Practice Address - Country:US
Practice Address - Phone:808-984-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15997164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse