1306066303 NPI number — ALICE C LELIUKAS RN CNM

Table of content: ALICE C LELIUKAS RN CNM (NPI 1306066303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306066303 NPI number — ALICE C LELIUKAS RN CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LELIUKAS
Provider First Name:
ALICE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306066303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96931-6578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-646-5825
Provider Business Mailing Address Fax Number:
671-646-3883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
548 S MARINE CORPS DR
Provider Second Line Business Practice Location Address:
FHP
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96913-3539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-646-5825
Provider Business Practice Location Address Fax Number:
671-646-3883
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RE0974 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: NP0058 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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