Healthcare Provider Details

I. General information

NPI: 1487923934
Provider Name (Legal Business Name): DEPARTMENT OF DEPENSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8601
  • Fax:
Mailing address:
  • Phone: 808-433-8601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number3737
License Number StateHI

VIII. Authorized Official

Name: JENNIFER JEANETTE QUINN-HASTINGS
Title or Position: LCSW
Credential: MSW, LCSW
Phone: 612-220-3757