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NPI Code Detail

MEDICARE: MS. MARY LOUISE LUNDY LICENSED NURSE

MEDICARE:  MS. MARY LOUISE LUNDY  LICENSED NURSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1376G00000XNursing Home Administrator000233AK

Other Identifiers

General Provider Information

NPI Number : 1598986754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY LOUISE LUNDY LICENSED NURSE
Provider Business Mailing Address
First Line : 3408 NORTH STAR STREET
Second Line :
City : ANCHORAGE
State : AK
Zip : 99503
Country : US
Telephone Number : 907-561-2244
Fax Number : 907-770-7903
Provider Business Practice Location Address
First Line : 3408 NORTH STAR STREET
Second Line :
City : ANCHORAGE
State : AK
Zip : 99503
Country : US
Telephone Number : 907-561-2244
Fax Number : 907-770-7903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 11/27/2009

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Directions to “ MS. MARY LOUISE LUNDY LICENSED NURSE” Practice Location

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