Healthcare Provider Details

I. General information

NPI: 1467473363
Provider Name (Legal Business Name): NICOLE FRANCOISE BOLENDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LINCOLN ST SUITE 100
KELSO WA
98626-1072
US

IV. Provider business mailing address

700 LINCOLN ST SUITE 100
KELSO WA
98626-1072
US

V. Phone/Fax

Practice location:
  • Phone: 360-425-5131
  • Fax: 360-425-5509
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD00016456
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00016456
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: