Healthcare Provider Details

I. General information

NPI: 1548097942
Provider Name (Legal Business Name): MRS. NITATOSE VI MISI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF VETERANS AFFAIRS 459 PATTERSON ROAD
HONOLULU HI
96819
US

IV. Provider business mailing address

P.O.BOX 1005 AMERICAN SAMOA VA CLINIC
PAGO PAGO AMERICAN SAMOA
96799
UM

V. Phone/Fax

Practice location:
  • Phone: 684-699-3730
  • Fax: 684-699-9147
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1071A
License Number StateAS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: