Provider Demographics
NPI:1447726708
Name:GAINES, TORRI LYNETTA
Entity type:Individual
Prefix:
First Name:TORRI
Middle Name:LYNETTA
Last Name:GAINES
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:NAVAL HEALTH CLINIC HAWAII
Mailing Address - Street 2:480 CENTRAL AVE
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4908
Mailing Address - Country:US
Mailing Address - Phone:808-474-4242
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC HAWAII
Practice Address - Street 2:480 CENTRAL AVENUE
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860
Practice Address - Country:US
Practice Address - Phone:808-474-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-88730163WG0000X
VA0001273109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice