Healthcare Provider Details

I. General information

NPI: 1760035059
Provider Name (Legal Business Name): JANGMOO SHERPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10928 EAGLE RIVER RD STE 254
EAGLE RIVER AK
99577-8080
US

IV. Provider business mailing address

895 LAKLOEY DR
NORTH POLE AK
99705-5355
US

V. Phone/Fax

Practice location:
  • Phone: 907-696-0221
  • Fax:
Mailing address:
  • Phone: 646-578-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number111722
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: