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NPI Code Detail

MEDICARE: MERCY TALIILAGI PULOU

MEDICARE: MERCY TALIILAGI PULOU
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1639814379
Entity Type Code : Individual
Provider Name (Legal Business Name) : MERCY TALIILAGI PULOU
Provider Business Mailing Address
First Line : 2502 EIDE ST APT 7
Second Line :
City : ANCHORAGE
State : AK
Zip : 99503-2630
Country : US
Telephone Number : 907-330-4312
Fax Number :
Provider Business Practice Location Address
First Line : 3710 E 20TH AVE
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-3418
Country : US
Telephone Number : 907-330-4312
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2022
Last Update Date : 04/27/2022

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Directions to “ MERCY TALIILAGI PULOU ” Practice Location

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