Provider Demographics
NPI:1811031313
Name:VETERAN'S AFFAIRS
Entity Type:Organization
Organization Name:VETERAN'S AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRIM
Authorized Official - Middle Name:K
Authorized Official - Last Name:WABUNOHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-562-4510
Mailing Address - Street 1:125 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4932
Mailing Address - Country:US
Mailing Address - Phone:203-562-4510
Mailing Address - Fax:
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:VETERANS AFFAIRS
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285345286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital