Provider Demographics
NPI:1811399769
Name:VAIFANUA, TALA
Entity Type:Individual
Prefix:
First Name:TALA
Middle Name:
Last Name:VAIFANUA
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 1:426 N BRAGAW ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1315
Mailing Address - Country:US
Mailing Address - Phone:907-244-1470
Mailing Address - Fax:
Practice Address - Street 1:426 N BRAGAW ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1315
Practice Address - Country:US
Practice Address - Phone:907-244-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider