Provider Demographics
NPI:1548097942
Name:MISI, NITATOSE VI
Entity type:Individual
Prefix:MRS
First Name:NITATOSE
Middle Name:VI
Last Name:MISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 1005
Mailing Address - Street 2:AMERICAN SAMOA VA CLINIC
Mailing Address - City:PAGO PAGO
Mailing Address - State:AMERICAN SAMOA
Mailing Address - Zip Code:96799
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - Street 2:459 PATTERSON ROAD
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:684-699-3730
Practice Address - Fax:684-699-9147
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS1071A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse