Provider Demographics
NPI:1255952784
Name:LOBUNKO, IEVGENII (LMT)
Entity type:Individual
Prefix:
First Name:IEVGENII
Middle Name:
Last Name:LOBUNKO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:EUGENE
Other - Middle Name:
Other - Last Name:LOBUNKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7731 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3572
Mailing Address - Country:US
Mailing Address - Phone:907-727-1901
Mailing Address - Fax:
Practice Address - Street 1:7731 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3572
Practice Address - Country:US
Practice Address - Phone:907-727-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK133898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist