Healthcare Provider Details

I. General information

NPI: 1235783457
Provider Name (Legal Business Name): JEBB SAGUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 N MULDOON RD STE 130
ANCHORAGE AK
99504-6110
US

IV. Provider business mailing address

1118 N MULDOON RD STE 130
ANCHORAGE AK
99504-6110
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number148448
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: