Provider Demographics
NPI:1437318540
Name:IBAY, ILUMINADA LINGAD (CNA)
Entity Type:Individual
Prefix:MRS
First Name:ILUMINADA
Middle Name:LINGAD
Last Name:IBAY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 RANDAMAR PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5720
Mailing Address - Country:US
Mailing Address - Phone:907-868-2738
Mailing Address - Fax:907-868-2738
Practice Address - Street 1:7619 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4814
Practice Address - Country:US
Practice Address - Phone:907-868-2738
Practice Address - Fax:907-868-2738
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100681376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator