Provider Demographics
NPI:1760626139
Name:HINOGUIN, NELLY GABONIA
Entity Type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:GABONIA
Last Name:HINOGUIN
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 1:181 W LANAI ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2816
Mailing Address - Country:US
Mailing Address - Phone:808-877-8089
Mailing Address - Fax:808-877-9011
Practice Address - Street 1:181 W LANAI ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2816
Practice Address - Country:US
Practice Address - Phone:808-877-8089
Practice Address - Fax:808-877-9011
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI020900938376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51096801Medicaid