Healthcare Provider Details

I. General information

NPI: 1982388724
Provider Name (Legal Business Name): MRS. ALISHA EMMA BOLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 FAIRBANKS ST UNIT E
ANCHORAGE AK
99503-4145
US

IV. Provider business mailing address

PO BOX 240823
ANCHORAGE AK
99524-0823
US

V. Phone/Fax

Practice location:
  • Phone: 907-302-1674
  • Fax: 907-268-4228
Mailing address:
  • Phone: 907-302-1674
  • Fax: 907-268-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: