MEDICARE: LYNDEL CUBBERLEY ARNP-C

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
1	363LF0000X	Family Nurse Practitioner	AP30006574	WA

General Provider Information

NPI Number	:	1063418739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDEL CUBBERLEY ARNP-C

Provider Business Mailing Address
First Line	:	7015 YEAZELL ROAD KP S
Second Line	:
City	:	LONGBRANCH
State	:	WA
Zip	:	98351-9534
Country	:	US
Telephone Number	:	253-884-5234
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 VETERANS DR SW
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98493-0003
Country	:	US
Telephone Number	:	253-583-1701
Fax Number	:	253-589-4166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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