Provider Demographics
NPI:1184729741
Name:ELISALA, BOBBIE LEHUANANI (APRN-RX)
Entity type:Individual
Prefix:MS
First Name:BOBBIE
Middle Name:LEHUANANI
Last Name:ELISALA
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:LEHUANANI
Other - Last Name:KELII
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-RX
Mailing Address - Street 1:94-216 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1922
Mailing Address - Country:US
Mailing Address - Phone:800-600-5197
Mailing Address - Fax:808-600-5194
Practice Address - Street 1:94-216 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1922
Practice Address - Country:US
Practice Address - Phone:800-600-5197
Practice Address - Fax:808-600-5194
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S16125Medicare UPIN
54724Medicare PIN