Provider Demographics
NPI:1386860971
Name:MOSSMAN, MARY K (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:MOSSMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:73-2360 KALOKO DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9167
Mailing Address - Country:US
Mailing Address - Phone:720-273-5915
Mailing Address - Fax:808-748-2909
Practice Address - Street 1:1221 KAPIOLANI BLVD STE 345
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3510
Practice Address - Country:US
Practice Address - Phone:808-308-5553
Practice Address - Fax:808-748-2909
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN58832163W00000X
HIAPRN-973364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse