Healthcare Provider Details

I. General information

NPI: 1881503522
Provider Name (Legal Business Name): JAHNNA BOESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE OTIS PKWY STE 220
ANCHORAGE AK
99508-5230
US

IV. Provider business mailing address

3418 W 80TH AVE
ANCHORAGE AK
99502-4421
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-3145
  • Fax:
Mailing address:
  • Phone: 907-450-9036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: