Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 57.025863 | OH |
N | 111NI0900X | Internist | 57.025863 | OH |
N | 207R00000X | Internist | MD60986433 | WA |
N | 111NI0900X | Internist | MD60986433 | WA |
Y | 207RI0200X | Infectious Disease | MD60986433 | WA |
NPI | 1093100273 |
---|---|
Provider Name | Medhavi Bole |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 13/09/2021 |