Provider Demographics
NPI:1841873957
Name:KUPUNA HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:KUPUNA HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DERRYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:808-936-1301
Mailing Address - Street 1:65-1158 MAMALAHOA HWY STE 8A
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8442
Mailing Address - Country:US
Mailing Address - Phone:808-740-5700
Mailing Address - Fax:808-442-0891
Practice Address - Street 1:65-1158 MAMALAHOA HWY STE 8A
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8442
Practice Address - Country:US
Practice Address - Phone:808-740-5700
Practice Address - Fax:808-442-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty