Provider Demographics
NPI:1467473363
Name:BOLENDER, NICOLE FRANCOISE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:FRANCOISE
Last Name:BOLENDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LINCOLN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-1072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 LINCOLN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-1072
Practice Address - Country:US
Practice Address - Phone:360-425-5131
Practice Address - Fax:360-425-5509
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000164562085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8363202Medicaid
WA8363202Medicaid
WAA15012Medicare UPIN