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Individual
VICKIE BOLL
Active
Individual
VICKIE BOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1392
NV
363A00000X
Physician Assistant
PA338
ID
363A00000X
Physician Assistant
Primary
PA60168389
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152179
BLUE SHIELD-DOWNEY
ID
01
—
000010152180
BLUE SHIELD-LAVA
ID
01
—
000010152181
BLUE SHIELD-POCATELLO
ID
01
—
000010152182
BLUE SHIELD-AM FALLS
ID
01
—
000010161109
BLUE SHIELD MCCAMMON
ID
05
—
1396737706
—
NV
05
—
2054118
—
WA
05
—
807226500
—
ID
01
—
HB721Z
MEDICARE PTAN
NV
01
—
PAE62
BLUE CROSS-MCCAMMON
ID
01
—
PAND8
BLUE CROSS-AM FALLS
ID
01
—
PANE5
BLUE CROSS-DOWNEY
ID
01
—
PANF3
BLUE CROSS-ABERDEEN
ID
01
—
PANG1
BLUE CROSS-LAVA
ID
01
—
PANH9
BLUE CROSS-POCATELLO
ID
Enumeration date
08/22/2005
Last updated
01/04/2017
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