Provider Demographics
NPI:1417333048
Name:BOHLING, MUKSARIN (PA)
Entity Type:Individual
Prefix:
First Name:MUKSARIN
Middle Name:
Last Name:BOHLING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MUKSARIN
Other - Middle Name:
Other - Last Name:HONGYIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4896
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:
Practice Address - Street 1:2005 W MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1762
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA173364363A00000X
363AM0700X
WAPA60848187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2047312Medicaid
OR500690913Medicaid