Provider Demographics
NPI:1265822506
Name:VA PACIFIC ISLAND HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:VA PACIFIC ISLAND HEALTH CARE SYSTEM
Other - Org Name:SPARK M MATSUNAGA VA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MEIHLANI
Authorized Official - Middle Name:CHYNNA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-RX, FNP
Authorized Official - Phone:808-748-1341
Mailing Address - Street 1:459 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1522
Mailing Address - Country:US
Mailing Address - Phone:808-748-1341
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-748-1341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty