Provider Demographics
NPI:1053153833
Name:YADAO, IMELDA (CNA)
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:
Last Name:YADAO
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 1:2900 KANANI ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1696
Mailing Address - Country:US
Mailing Address - Phone:808-378-4343
Mailing Address - Fax:
Practice Address - Street 1:2900 KANANI ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1696
Practice Address - Country:US
Practice Address - Phone:808-245-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5-130029253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency