Healthcare Provider Details

I. General information

NPI: 1942707807
Provider Name (Legal Business Name): JESSICA BOATENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

5821 HOBART ST
PITTSBURGH PA
15217-2109
US

V. Phone/Fax

Practice location:
  • Phone: 421-864-9344
  • Fax:
Mailing address:
  • Phone: 313-410-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberOS023094
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: