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General NPI Number Information
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NPI Number | 1417321928
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Entity Type | Individual
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Provider Name | MARIANA BOSNJAK PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 34300 S TALKEETNA SPUR ROAD
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City | TALKEETNA
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State | AK
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Zip | 99676-9701
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Country | US
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Telephone | 907-733-2273
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Fax | 907-733-1735
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Provider Business Mailing Address
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Address Line | HC 89 BOX 8190
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City | TALKEETNA
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State | AK
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Zip | 99676-9701
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Country | US
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Telephone | 907-733-2273
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Fax | 907-733-1735
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 52701
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License Number State | CA
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