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General NPI Number Information
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NPI Number | 1366355737
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Entity Type | Individual
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Provider Name | KERI RENEE BOLIN
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Gender | Female
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 4305 E TRENT AVE
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City | SPOKANE
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State | WA
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Zip | 99212-1315
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Country | US
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Telephone | 330-621-8066
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Fax |
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Provider Business Mailing Address
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Address Line | 3421 S MYRTLE ST
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City | SPOKANE
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State | WA
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Zip | 99223-5902
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 171765
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License Number State | OH
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