Provider Demographics
NPI:1053459602
Name:PROCTOR, SETH KUNIO (RN)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:KUNIO
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2528
Mailing Address - Country:US
Mailing Address - Phone:808-984-2150
Mailing Address - Fax:808-984-2155
Practice Address - Street 1:121 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2528
Practice Address - Country:US
Practice Address - Phone:808-984-2150
Practice Address - Fax:808-984-2155
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-49341163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult