Healthcare Provider Details

I. General information

NPI: 1548177561
Provider Name (Legal Business Name): ADI KELERA Q D NIUMATAIWALU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 3965
PAGO PAGO AS
96799-3965
US

IV. Provider business mailing address

PO BOX 3965
PAGO PAGO AS
96799-3965
US

V. Phone/Fax

Practice location:
  • Phone: 684-699-6380
  • Fax:
Mailing address:
  • Phone: 684-699-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60001C
License Number StateAS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: