Provider Demographics
NPI:1487307856
Name:CASTILLEJO, ROWELLMOND MARCHELLE NICOLAS (RN)
Entity type:Individual
Prefix:
First Name:ROWELLMOND MARCHELLE
Middle Name:NICOLAS
Last Name:CASTILLEJO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-214 OA ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5241
Mailing Address - Country:US
Mailing Address - Phone:808-636-8159
Mailing Address - Fax:
Practice Address - Street 1:98-214 OA ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5241
Practice Address - Country:US
Practice Address - Phone:808-636-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-81721163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000904Medicaid