Healthcare Provider Details

I. General information

NPI: 1659056711
Provider Name (Legal Business Name): MAURINE CK BOLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 46TH AVE SW
SEATTLE WA
98136-2403
US

IV. Provider business mailing address

6523 CALIFORNIA AVE SW STE 273
SEATTLE WA
98136-1833
US

V. Phone/Fax

Practice location:
  • Phone: 425-428-2966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61197927
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: