Provider Demographics
NPI:1104323161
Name:LUNGER, EVAN (LPN)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:
Last Name:LUNGER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-3304
Mailing Address - Country:US
Mailing Address - Phone:253-983-2200
Mailing Address - Fax:
Practice Address - Street 1:54 SENTINEL DR
Practice Address - Street 2:
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-1663
Practice Address - Country:US
Practice Address - Phone:253-983-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60772369164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALP60772369OtherLICENSED PRACTICAL NURSE