Provider Demographics
NPI:1124424312
Name:BOISVERT, JON-PAUL (EAMP)
Entity type:Individual
Prefix:MR
First Name:JON-PAUL
Middle Name:
Last Name:BOISVERT
Suffix:
Gender:M
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18208 66TH AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-7949
Mailing Address - Country:US
Mailing Address - Phone:425-814-2045
Mailing Address - Fax:425-814-2738
Practice Address - Street 1:18208 66TH AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-7949
Practice Address - Country:US
Practice Address - Phone:425-814-2045
Practice Address - Fax:425-814-2738
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60504883171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist