Provider Demographics
NPI:1063418739
Name:CUBBERLEY, LYNDEL (ARNP-C)
Entity type:Individual
Prefix:
First Name:LYNDEL
Middle Name:
Last Name:CUBBERLEY
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:LINDY
Other - Middle Name:
Other - Last Name:CUBBERLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7015 YEAZELL ROAD KP S
Mailing Address - Street 2:
Mailing Address - City:LONGBRANCH
Mailing Address - State:WA
Mailing Address - Zip Code:98351-9534
Mailing Address - Country:US
Mailing Address - Phone:253-884-5234
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DR SW
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0003
Practice Address - Country:US
Practice Address - Phone:253-583-1701
Practice Address - Fax:253-589-4166
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily