Provider Demographics
NPI:1639136005
Name:BOSWELL, SONJA JANET (PA)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:JANET
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:JANET
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-0123
Mailing Address - Fax:918-293-3184
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-0123
Practice Address - Fax:918-293-3184
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1190363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00164929OtherRR MEDICARE
OKP53946Medicare UPIN