1518414671 NPI number — JUANITA KAY DUBRAY RN

Table of content: JUANITA KAY DUBRAY RN (NPI 1518414671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518414671 NPI number — JUANITA KAY DUBRAY RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUBRAY
Provider First Name:
JUANITA
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUARDIPEE
Provider Other First Name:
JUANITA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518414671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNING
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59417-3011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-338-4415
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 HOSPITAL CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNING
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59417-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-338-6377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2016

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: 163W00000X , with the licence number:  NUR-RN-LIC-30114 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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