Healthcare Provider Details

I. General information

NPI: 1023343555
Provider Name (Legal Business Name): JENNIFER ANN MCGRATH ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2009
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 W 104TH AVE
ANCHORAGE AK
99515
US

IV. Provider business mailing address

2520 WINTERCHASE CIR
ANCHORAGE AK
99516-1974
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax:
Mailing address:
  • Phone: 907-345-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1111
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: