Provider Demographics
NPI:1871234401
Name:MANU, AIULUTUANAITAISI
Entity Type:Individual
Prefix:
First Name:AIULUTUANAITAISI
Middle Name:
Last Name:MANU
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 1:360 W BENSON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3953
Mailing Address - Country:US
Mailing Address - Phone:907-565-1200
Mailing Address - Fax:
Practice Address - Street 1:611 W 47TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7138
Practice Address - Country:US
Practice Address - Phone:907-569-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health