Provider Demographics
NPI:1104640507
Name:LUBINGA, JOAN IMMACULATE (RN)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:IMMACULATE
Last Name:LUBINGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:IMMACULATE
Other - Last Name:KYAKUNZIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 SYMMES CIR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-2973
Mailing Address - Country:US
Mailing Address - Phone:508-250-7379
Mailing Address - Fax:
Practice Address - Street 1:1105 SYMMES CIR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-2973
Practice Address - Country:US
Practice Address - Phone:508-250-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2392107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse