Provider Demographics
NPI:1821619156
Name:BUAN, RESURRECCION BUMANGLAG (CNA)
Entity Type:Individual
Prefix:MRS
First Name:RESURRECCION
Middle Name:BUMANGLAG
Last Name:BUAN
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 1:91-1044 UOUOA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3593
Mailing Address - Country:US
Mailing Address - Phone:808-223-6497
Mailing Address - Fax:808-671-1726
Practice Address - Street 1:91-1044 UOUOA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3593
Practice Address - Country:US
Practice Address - Phone:808-223-6497
Practice Address - Fax:808-671-1726
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-100030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI754714Medicaid