Provider Demographics
NPI:1306542055
Name:BORDONADA, KELSIE PASCUAL (RN, MSN, AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELSIE
Middle Name:PASCUAL
Last Name:BORDONADA
Suffix:
Gender:F
Credentials:RN, MSN, AGACNP-BC
Other - Prefix:MS
Other - First Name:KELSIE
Other - Middle Name:GREGORIO
Other - Last Name:PASCUAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:91-2071 KAMAKANA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6416
Mailing Address - Country:US
Mailing Address - Phone:808-292-7994
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-691-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-66012163WM0705X
HIAPRN-3967363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty