Provider Demographics
NPI:1598253338
Name:BOLANOS, SARAH LEE DEVERA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:SARAH LEE
Middle Name:DEVERA
Last Name:BOLANOS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11612 185TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-6464
Mailing Address - Country:US
Mailing Address - Phone:951-902-5351
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE ATTN: MCHJ-CLQ-C
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95027622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily