Provider Demographics
NPI:1891925277
Name:NIUMATAIWALU, KOLINIO (MBBS, DA)
Entity Type:Individual
Prefix:DR
First Name:KOLINIO
Middle Name:
Last Name:NIUMATAIWALU
Suffix:
Gender:M
Credentials:MBBS, DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX LBJ
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-0010
Mailing Address - Country:US
Mailing Address - Phone:684-699-9681
Mailing Address - Fax:
Practice Address - Street 1:PO BOX LBJ
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-0010
Practice Address - Country:US
Practice Address - Phone:684-699-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS3064-C367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant