Healthcare Provider Details

I. General information

NPI: 1144853953
Provider Name (Legal Business Name): VICTORINA NUGENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HEALTH CLINIC HAWAII 480 CENTRAL AVE
JOINT BASE PEARL HARBOR HICKAM HI
96860-4908
US

IV. Provider business mailing address

110 MAPLE VIEW CT
HEMLOCK MI
48626-9419
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-1880
  • Fax:
Mailing address:
  • Phone: 808-829-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN76215
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: