Healthcare Provider Details

I. General information

NPI: 1598986754
Provider Name (Legal Business Name): MARY LOUISE LUNDY LICENSED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 NORTH STAR STREET
ANCHORAGE AK
99503
US

IV. Provider business mailing address

3408 NORTH STAR STREET
ANCHORAGE AK
99503
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-2244
  • Fax: 907-770-7903
Mailing address:
  • Phone: 907-561-2244
  • Fax: 907-770-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number000233
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: