MEDICARE: MRS. JOSEPHINE L LUBATON RN

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	310400000X	Assisted Living Facility	100540	AK

General Provider Information

NPI Number	:	1649305798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOSEPHINE L LUBATON RN

Provider Business Mailing Address
First Line	:	1720 ADONIS DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-1486
Country	:	US
Telephone Number	:	907-929-4819
Fax Number	:	907-929-3819

Provider Business Practice Location Address
First Line	:	1720 ADONIS DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-1486
Country	:	US
Telephone Number	:	907-929-4819
Fax Number	:	907-929-3819

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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