Provider Demographics
NPI:1447856869
Name:AMITUANAI, ADRIANNE SOSEFINA (PA)
Entity type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:SOSEFINA
Last Name:AMITUANAI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MDG/SGXP
Mailing Address - Street 2:101 BODIN CIRCLE
Mailing Address - City:TRAVIS AIR FORCE BASE
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:707-423-3909
Mailing Address - Fax:
Practice Address - Street 1:60 MDG/SGXP
Practice Address - Street 2:101 BODIN CIRCLE
Practice Address - City:TRAVIS AIR FORCE BASE
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical