Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP30005828 | WA |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | AP30005828 | WA |
NPI | 1811928187 |
---|---|
Provider Name | Vicki K Bolton |
First Address | Spokane Valley, WA 99216-1043 |
Second Address | Spokane Valley, WA 99216-1043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 16/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9630351 | (05) | WA |
P27022 | (02) | WA |