Provider Demographics
NPI:1982388724
Name:BOLIN, ALISHA EMMA
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:EMMA
Last Name:BOLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 MC CAIN LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5615
Mailing Address - Country:US
Mailing Address - Phone:907-302-1674
Mailing Address - Fax:
Practice Address - Street 1:624 W INTERNATIONAL AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1151
Practice Address - Country:US
Practice Address - Phone:907-302-1674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK246R00000X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology