Healthcare Provider Details

I. General information

NPI: 1386860971
Provider Name (Legal Business Name): MARY K MOSSMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY K TRUJILLO APRN

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 KAPIOLANI BLVD STE 345
HONOLULU HI
96814-3510
US

IV. Provider business mailing address

73-2360 KALOKO DR
KAILUA KONA HI
96740-9167
US

V. Phone/Fax

Practice location:
  • Phone: 808-308-5553
  • Fax: 808-748-2909
Mailing address:
  • Phone: 720-273-5915
  • Fax: 808-748-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN58832
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN-973
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: