Provider Demographics
NPI:1922579051
Name:BARAHONA, NOLVIA (CPC)
Entity Type:Individual
Prefix:MRS
First Name:NOLVIA
Middle Name:
Last Name:BARAHONA
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 BOULEVARD PARK CT SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4306
Mailing Address - Country:US
Mailing Address - Phone:360-489-7970
Mailing Address - Fax:
Practice Address - Street 1:627 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3504
Practice Address - Country:US
Practice Address - Phone:360-763-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG60877000Medicaid