Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 2062-A | AS |
NPI | 1003208703 |
---|---|
Provider Name | Elizabeth H Lauvao |
First Address | Pago Pago, AS 96799 |
Second Address | Pago Pago, AS 96799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2015 |
Last Update Date | 04/03/2015 |