Healthcare Provider Details

I. General information

NPI: 1942025085
Provider Name (Legal Business Name): HILARY LACSON VITUG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NAVAL HOSPITAL, OKINAWA, CAMP FOSTER
FPO AP
96362
JP

IV. Provider business mailing address

PSC 557 BOX 974
FPO AP
96379-0010
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone: 703-328-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-83956
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: