Provider Demographics
NPI:1669971917
Name:TEA, SULIETILOLOHEA (CHA III)
Entity type:Individual
Prefix:
First Name:SULIETILOLOHEA
Middle Name:
Last Name:TEA
Suffix:
Gender:F
Credentials:CHA III
Other - Prefix:
Other - First Name:LOLO
Other - Middle Name:
Other - Last Name:TEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3105 WILLOW ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1971
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3051 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANAKTUVUK PASS
Practice Address - State:AK
Practice Address - Zip Code:99721
Practice Address - Country:US
Practice Address - Phone:907-661-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker