Provider Demographics
NPI:1518968403
Name:SONNENBURG, JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SONNENBURG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-0808
Mailing Address - Country:US
Mailing Address - Phone:509-363-3100
Mailing Address - Fax:509-363-0300
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:STE. C-308
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2961
Practice Address - Country:US
Practice Address - Phone:907-272-3366
Practice Address - Fax:907-272-0269
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK759363AM0700X
WAPA61298356363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA61298356OtherSTATE LICENSE