MEDICARE: MRS. CINDA JO BOLETTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	VA00058647	WA

General Provider Information

NPI Number	:	1124063847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CINDA JO BOLETTE

Provider Business Mailing Address
First Line	:	5439 6TH AVE NW
Second Line	:
City	:	TULALIP
State	:	WA
Zip	:	98271-6530
Country	:	US
Telephone Number	:	360-659-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	5439 6TH AVE NW
Second Line	:
City	:	TULALIP
State	:	WA
Zip	:	98271-6530
Country	:	US
Telephone Number	:	360-659-7003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/08/2007

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