MEDICARE: MS. JOAN LUCIENNE JUNGE ANP CNM

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	171M00000X	Case Manager/Care Coordinator
2	363L00000X	Nurse Practitioner	178	AK

General Provider Information

NPI Number	:	1396728614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN LUCIENNE JUNGE ANP CNM

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

Provider Business Practice Location Address
First Line	:	1500 KANAKANAK RD
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576
Country	:	US
Telephone Number	:	907-842-4569
Fax Number	:	907-842-4550

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	11/30/2009

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