=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619813524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HONOLULU VAMC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2026
-----------------------------------------------------
Last Update Date | 04/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 CHALAN CABOT
-----------------------------------------------------
City | DEDEDO
-----------------------------------------------------
State | GU
-----------------------------------------------------
Zip | 96929-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-341-3020
-----------------------------------------------------
Fax | 702-341-3503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 94406
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44101-4406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-341-3020
-----------------------------------------------------
Fax | 702-341-3503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NPI TEAM
-----------------------------------------------------
Name | ERIN DENISE POTTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-382-2579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QV0200X
-----------------------------------------------------
Taxonomy Name | VA Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------