Provider Demographics
NPI:1689024051
Name:JUNEAU QUICK CARE
Entity Type:Organization
Organization Name:JUNEAU QUICK CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTONI
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:330-998-5252
Mailing Address - Street 1:1015 EDWIN PL
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9553
Mailing Address - Country:US
Mailing Address - Phone:330-998-5252
Mailing Address - Fax:
Practice Address - Street 1:1015 EDWIN PL
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9553
Practice Address - Country:US
Practice Address - Phone:330-998-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURU1489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty