Individual
JACOB D BOSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-2000
(360) 414-7638
Mailing address
324 N EMPORIA AVE APT 611, WICHITA, KS 67202-2554
(503) 516-8419
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
149114
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
AP61201940
WA
Other
Enumeration date
08/04/2021
Last updated
03/19/2026
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