Provider Demographics
NPI:1912975988
Name:FUIMAONO, SIOELI FIATAU (PA)
Entity Type:Individual
Prefix:MR
First Name:SIOELI
Middle Name:FIATAU
Last Name:FUIMAONO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 319
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-986-1256
Mailing Address - Fax:615-383-0873
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:SUITE 319
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-986-1256
Practice Address - Fax:615-383-0873
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1326363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3060214Medicaid
TN4116189OtherBCBS
TN3664072Medicare ID - Type Unspecified
TNP00305797Medicare PIN
TN0922510004Medicare PIN
TN3060214Medicaid