Provider Demographics
NPI:1255835252
Name:JOSEPH, SUMREAY (LPN, LVN)
Entity Type:Individual
Prefix:
First Name:SUMREAY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LPN, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5446 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2568
Mailing Address - Country:US
Mailing Address - Phone:919-584-7603
Mailing Address - Fax:
Practice Address - Street 1:121 W FIREWEED LN STE 105
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2044
Practice Address - Country:US
Practice Address - Phone:907-863-9653
Practice Address - Fax:907-863-9124
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192920164X00000X
AK7073164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse