Provider Demographics
NPI:1306066303
Name:LELIUKAS, ALICE C (RN CNM)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:C
Last Name:LELIUKAS
Suffix:
Gender:F
Credentials:RN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6578
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-6578
Mailing Address - Country:US
Mailing Address - Phone:671-646-5825
Mailing Address - Fax:671-646-3883
Practice Address - Street 1:548 S MARINE CORPS DR
Practice Address - Street 2:FHP
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3539
Practice Address - Country:US
Practice Address - Phone:671-646-5825
Practice Address - Fax:671-646-3883
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURE0974163W00000X
NP0058367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P74121Medicare UPIN