Provider Demographics
NPI:1023650645
Name:MATAIA, LEUE T
Entity type:Individual
Prefix:
First Name:LEUE
Middle Name:T
Last Name:MATAIA
Suffix:
Gender:F
Credentials:
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 241465
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1465
Mailing Address - Country:US
Mailing Address - Phone:907-258-1141
Mailing Address - Fax:907-258-1527
Practice Address - Street 1:3722 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1216
Practice Address - Country:US
Practice Address - Phone:907-258-1141
Practice Address - Fax:907-258-1527
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider