Healthcare Provider Details

I. General information

NPI: 1881146918
Provider Name (Legal Business Name): SIENH CINDY BOUTSOMSI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 CARA LOOP
ANCHORAGE AK
99515-3851
US

IV. Provider business mailing address

1641 CARA LOOP
ANCHORAGE AK
99515-3851
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-5342
  • Fax:
Mailing address:
  • Phone: 907-222-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberNURR25627
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: