Healthcare Provider Details

I. General information

NPI: 1568686368
Provider Name (Legal Business Name): NAVAL HEALTH CLINIC HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE
PEARL HARBOR HI
96860-4908
US

IV. Provider business mailing address

480 CENTRAL AVE
PEARL HARBOR HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 808-471-1866
  • Fax:
Mailing address:
  • Phone: 808-473-1880
  • Fax: 808-473-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number55912
License Number StateHI

VIII. Authorized Official

Name: MRS. KIMBERLY ELLEN DUBOIS
Title or Position: NURSE
Credential: R.N.
Phone: 808-590-1728