Provider Demographics
NPI:1053787143
Name:FAASALELE, KIMA (CERTIFIED MIDWIFE)
Entity type:Individual
Prefix:
First Name:KIMA
Middle Name:
Last Name:FAASALELE
Suffix:
Gender:F
Credentials:CERTIFIED MIDWIFE
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 2168
Mailing Address - Street 2:PAGO PAGO
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-2168
Mailing Address - Country:US
Mailing Address - Phone:168-425-2497
Mailing Address - Fax:
Practice Address - Street 1:PROCUREMENT ROAD
Practice Address - Street 2:TAFUNA FAMILY HEALTH CENTER
Practice Address - City:TAFUNA
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-699-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS1203176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife