Healthcare Provider Details

I. General information

NPI: 1053459602
Provider Name (Legal Business Name): SETH KUNIO PROCTOR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MAHALANI ST
WAILUKU HI
96793-2528
US

IV. Provider business mailing address

121 MAHALANI ST
WAILUKU HI
96793-2528
US

V. Phone/Fax

Practice location:
  • Phone: 808-984-2150
  • Fax: 808-984-2155
Mailing address:
  • Phone: 808-984-2150
  • Fax: 808-984-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN-49341
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: