Provider Demographics
NPI:1356559892
Name:NAMULAUTI, FAALELE S (CNA)
Entity type:Individual
Prefix:
First Name:FAALELE
Middle Name:S
Last Name:NAMULAUTI
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 E 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3981
Mailing Address - Country:US
Mailing Address - Phone:907-278-4534
Mailing Address - Fax:907-646-9861
Practice Address - Street 1:1054 E 28TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3981
Practice Address - Country:US
Practice Address - Phone:907-278-4534
Practice Address - Fax:907-646-9861
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK433060310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility