Provider Demographics
NPI:1962245548
Name:MAUGA-ALE, FAASALA THERESA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:FAASALA
Middle Name:THERESA
Last Name:MAUGA-ALE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 PECAN MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-8272
Mailing Address - Country:US
Mailing Address - Phone:253-363-1710
Mailing Address - Fax:
Practice Address - Street 1:268 PECAN MEADOW LN
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-8272
Practice Address - Country:US
Practice Address - Phone:253-363-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691988163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory