Healthcare Provider Details

I. General information

NPI: 1518889369
Provider Name (Legal Business Name): GLADYS MARNELLI PEGA BUMANGLAG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLADYS MARNELLI TRINIDAD BUMANGLAG RN

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

91-1837 KOHANAHANA LOOP
EWA BEACH HI
96706-7852
US

V. Phone/Fax

Practice location:
  • Phone: 833-983-0487
  • Fax:
Mailing address:
  • Phone: 719-757-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-113368
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: