Individual
MARY THERESA SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1651 MOTT-SMITH DR APT D, HONOLULU, HI 96822-2802
(808) 202-1534
Mailing address
1651 MOTT-SMITH DR APT D, HONOLULU, HI 96822-2802
(808) 202-1534
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
65441
HI
Other
Enumeration date
04/18/2019
Last updated
04/18/2019
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