1396728614 NPI number — MS. JOAN LUCIENNE JUNGE ANP CNM

Table of content: MS. JOAN LUCIENNE JUNGE ANP CNM (NPI 1396728614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396728614 NPI number — MS. JOAN LUCIENNE JUNGE ANP CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUNGE
Provider First Name:
JOAN
Provider Middle Name:
LUCIENNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ANP CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BECKERT
Provider Other First Name:
JOAN
Provider Other Middle Name:
LUCIENNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396728614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 944
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DILLINGHAM
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99576-0944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-842-4569
Provider Business Mailing Address Fax Number:
907-842-4550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 KANAKANAK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DILLINGHAM
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-842-4569
Provider Business Practice Location Address Fax Number:
907-842-4550
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 178 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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