Provider Demographics
NPI:1811077332
Name:BOLANOS, JAMES M (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:BOLANOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:520 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6697
Practice Address - Country:US
Practice Address - Phone:509-662-2211
Practice Address - Fax:509-662-8756
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002147363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA322540OtherWVH LNI
WA1811077332Medicaid
WAP01428922OtherRR MEDICARE WVH
WAG8926704, G8926705Medicare PIN