Provider Demographics
NPI:1063525145
Name:BOGA, JEAN A (ANP)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:A
Last Name:BOGA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:A
Other - Last Name:BOGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:701 E TUDOR RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7457
Mailing Address - Country:US
Mailing Address - Phone:907-644-8044
Mailing Address - Fax:907-644-8004
Practice Address - Street 1:701 E TUDOR RD
Practice Address - Street 2:SUITE 135
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7457
Practice Address - Country:US
Practice Address - Phone:907-644-8044
Practice Address - Fax:907-644-8004
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK212363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2946Medicaid
AK150608Medicare ID - Type Unspecified
AK2946Medicaid