Provider Demographics
| NPI: | 1396728614 |
|---|---|
| Name: | JUNGE, JOAN LUCIENNE (ANP CNM) |
| Entity type: | Individual |
| Prefix: | MS |
| First Name: | JOAN |
| Middle Name: | LUCIENNE |
| Last Name: | JUNGE |
| Suffix: | |
| Gender: | F |
| Credentials: | ANP CNM |
| Other - Prefix: | MS |
| Other - First Name: | JOAN |
| Other - Middle Name: | LUCIENNE |
| Other - Last Name: | BECKERT |
| Other - Suffix: | |
| Other - Last Name Type: | Former Name |
| Other - Credentials: | CNM |
| Mailing Address - Street 1: | PO BOX 944 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DILLINGHAM |
| Mailing Address - State: | AK |
| Mailing Address - Zip Code: | 99576-0944 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 907-842-4569 |
| Mailing Address - Fax: | 907-842-4550 |
| Practice Address - Street 1: | 1500 KANAKANAK RD |
| Practice Address - Street 2: | |
| Practice Address - City: | DILLINGHAM |
| Practice Address - State: | AK |
| Practice Address - Zip Code: | 99576 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 907-842-4569 |
| Practice Address - Fax: | 907-842-4550 |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2005-11-21 |
| Last Update Date: | 2009-11-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 171M00000X | ||
| AK | 178 | 363L00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| 8EZ642 | Medicare ID - Type Unspecified | ||
| 8EZ652 | Medicare ID - Type Unspecified | ||
| 8EZ692 | Medicare ID - Type Unspecified | ||
| 8EZ702 | Medicare ID - Type Unspecified | ||
| 8EZ522 | Medicare ID - Type Unspecified | ||
| 8EZ662 | Medicare ID - Type Unspecified | ||
| 8EZ672 | Medicare ID - Type Unspecified | ||
| 8EZ542 | Medicare ID - Type Unspecified | ||
| 8EZ552 | Medicare ID - Type Unspecified | ||
| 8EZ602 | Medicare ID - Type Unspecified | ||
| 8EZ682 | Medicare ID - Type Unspecified | ||
| 8EZ632 | Medicare ID - Type Unspecified | ||
| 8EZ722 | Medicare ID - Type Unspecified | ||
| 8EZ503 | Medicare ID - Type Unspecified | ||
| 8EZ513 | Medicare ID - Type Unspecified | ||
| 8EZ532 | Medicare ID - Type Unspecified | ||
| 8EZ622 | Medicare ID - Type Unspecified | ||
| P39673 | Medicare UPIN | ||
| 8EZ712 | Medicare ID - Type Unspecified | ||
| 8EZ612 | Medicare ID - Type Unspecified |
