MEDICARE: MS. JEAN A BOGA ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	212	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063525145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN A BOGA ANP

Provider Business Mailing Address
First Line	:	701 E TUDOR RD
Second Line	:	SUITE 135
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7457
Country	:	US
Telephone Number	:	907-644-8044
Fax Number	:	907-644-8004

Provider Business Practice Location Address
First Line	:	701 E TUDOR RD
Second Line	:	SUITE 135
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7457
Country	:	US
Telephone Number	:	907-644-8044
Fax Number	:	907-644-8004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	05/23/2013

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