Provider Demographics
NPI:1720892904
Name:MATAGAONO, ANNABELLE TULEI
Entity type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:TULEI
Last Name:MATAGAONO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ANNABELLE
Other - Middle Name:TULEI
Other - Last Name:MATAGAONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8970 SICILY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9712
Mailing Address - Country:US
Mailing Address - Phone:253-466-8374
Mailing Address - Fax:
Practice Address - Street 1:8970 SICILY LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9712
Practice Address - Country:US
Practice Address - Phone:253-466-8374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider