Provider Demographics
NPI:1669586715
Name:BOLZENDAHL, CAROLINE FIELD (ARNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:FIELD
Last Name:BOLZENDAHL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:T
Other - Last Name:FIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15515 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1504
Mailing Address - Country:US
Mailing Address - Phone:360-571-9416
Mailing Address - Fax:
Practice Address - Street 1:12607 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6055
Practice Address - Country:US
Practice Address - Phone:360-891-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA AP30003767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily