Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 1203 | AS |
NPI | 1053787143 |
---|---|
Provider Name | Kima Faasalele |
First Address | Pago Pago, AS 96799-2168 |
Second Address | Tafuna, AS 96799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2015 |
Last Update Date | 12/08/2015 |