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General NPI Number Information
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NPI Number | 1063349983
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Entity Type | Organization
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Legal Business Name | SELF CENTERED, LLC
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 647 PAOPUA LOOP
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City | KAILUA
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State | HI
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Zip | 96734-3535
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Country | US
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Telephone | 808-994-6444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1224
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City | KAILUA
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State | HI
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Zip | 96734-1224
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Country | US
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Telephone | 808-994-6444
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. R S HUNDERTMARK
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Credential | DNP, APRN, PMHNP-C
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Telephone | 808-994-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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