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Deactivated NPI 1053586768 Deactivated / Inactive NPI Female Practitioner

Dr. Mary Jane Amundson , PhD, APRN

Licensed Practical Nurse • Honolulu, HI

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Mary Jane Amundson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 23, 2008
NPI Deactivation Date April 24, 2025
Total Practice Duration ~17 Years of Practice (2008 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Mary Jane Amundson, PhD, APRN was a registered Licensed Practical Nurse practicing in Honolulu, HI. Throughout an active medical career spanning 17 years, Dr. Amundson provided care at the practice location at 615 PIIKOI ST until profile deactivation on 2025-04-24.

Practice Location & Contact Primary Location

Practice Address

615 Piikoi St
Suite 105

Honolulu, HI 968143116

Telephone 8085968433
Associated Practice Facility / Clinic
🏢 Tyrie Lee Jenkins, M.d., Inc. Facility NPI 1295791135

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Honolulu, HI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
39 Specialists

Practicing in Honolulu, HI (159 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License HI APRN - 11

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

17 Associated Practitioners
Charles Neumann

Counselor - Mental Health

NPI 1043469810
NPI 1073867354

BACHELORSPSYCHOLOGY

NPI 1104009257

Doctor of Psychology (Psy.D.)

Gregg Kauihou , MSW, MS

Counselor - Mental Health

NPI 1154579019

Master of Social Work, Master of Science

Darren Kubota

Student in an Organized Health Care Education/Training Program

NPI 1184974834
Lisa Casados

Counselor - Mental Health

NPI 1275879777

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated April 24, 2025

Record deactivated on April 24, 2025

NPI Profile Active April 23, 2008

NPI status registered as active in NPPES database

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Updated Practice Location April 23, 2008

Registered at 615 PIIKOI ST, SUITE 105, HONOLULU, HI 968143116 (Tel: 8085968433)

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Updated Business Mailing Address April 23, 2008

Registered at 615 PIIKOI ST, SUITE 105, HONOLULU, HI 968143116 (Tel: 8085968433)

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Provider Name / Credentials Updated April 23, 2008

Recorded as MARY JANE AMUNDSON, PH. D., APRN

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 23, 2008

Licensed Practical Nurse (License #APRN - 11 in HI)

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Initial NPI Registration & Enumeration April 23, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1053586768
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 23, 2008
Last Update: April 23, 2008
Deactivation Date: April 24, 2025

Mailing Address

615 Piikoi St, Suite 105

Honolulu, HI 968143116

Phone: 8085968433

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.