Provider Demographics
NPI:1417321928
Name:BOSNJAK, MARIANA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:BOSNJAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:
Other - Last Name:BRIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HC 89 BOX 8190
Mailing Address - Street 2:
Mailing Address - City:TALKEETNA
Mailing Address - State:AK
Mailing Address - Zip Code:99676-9701
Mailing Address - Country:US
Mailing Address - Phone:907-733-2273
Mailing Address - Fax:907-733-1735
Practice Address - Street 1:34300 S TALKEETNA SPUR ROAD
Practice Address - Street 2:
Practice Address - City:TALKEETNA
Practice Address - State:AK
Practice Address - Zip Code:99676-9701
Practice Address - Country:US
Practice Address - Phone:907-733-2273
Practice Address - Fax:907-733-1735
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant