Provider Demographics
NPI:1619599040
Name:BOLOGAN, ANA-IRINA
Entity Type:Individual
Prefix:
First Name:ANA-IRINA
Middle Name:
Last Name:BOLOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 NE 132ND ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2900
Mailing Address - Country:US
Mailing Address - Phone:425-899-5800
Mailing Address - Fax:425-899-5806
Practice Address - Street 1:11911 NE 132ND ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2900
Practice Address - Country:US
Practice Address - Phone:425-899-5800
Practice Address - Fax:425-899-5806
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60575264163WR0006X
WAAP61204155363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant