Bolduc, Jennifer L

Bolduc, Jennifer L is an individual health care provider with primary practice located at 55 W Tietan St , Walla Walla WA 99362-4445. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Bolduc, Jennifer L can be contacted via phone (509) 525-3720.

Contact Information

Primary practice address
55 W Tietan St Walla Walla WA 99362-4445
Phone: (509) 525-3720
Fax: (509) 522-1578
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD00042057 Washington

Profile Details

NPI number 1033183256
LBN Legal business name Bolduc, Jennifer L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Nov 27th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033183256 NPPES
Washington Other 172310 L&I
Washington MEDICAID 8364531 L&I
Washington MEDICAID 299828 L&I
Washington Other P00016419 L&I

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