Individual
JILL BOOSHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHA IV
Contact information
Practice address
190 CLINIC ROAD, BOX 190, GAMBELL, AK 99742-0190
(907) 985-5015
(907) 985-5085
Mailing address
190 CLINIC ROAD, BOX 190, GAMBELL, AK 99742-0190
(907) 985-5015
(907) 985-5085
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
03-602-IV
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CHA-IV
03-602-IV
AK
Enumeration date
11/23/2011
Last updated
11/23/2011
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