Healthcare Provider Details

I. General information

NPI: 1841873957
Provider Name (Legal Business Name): KUPUNA HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65-1158 MAMALAHOA HWY STE 8A
KAMUELA HI
96743-8442
US

IV. Provider business mailing address

65-1158 MAMALAHOA HWY STE 8A
KAMUELA HI
96743-8442
US

V. Phone/Fax

Practice location:
  • Phone: 808-740-5700
  • Fax: 808-442-0891
Mailing address:
  • Phone: 808-740-5700
  • Fax: 808-442-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIA DERRYBERRY
Title or Position: NURSE PRACTITIONER
Credential: ANP-BC
Phone: 808-936-1301