# VICKIE BOLL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1396737706
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA1392 | NV | — |
| 363A00000X | Physician Assistant | PA338 | ID | — |
| 363A00000X | Physician Assistant | PA60168389 | WA | Yes |

## Other

- **Enumeration date:** 08/22/2005
- **Last updated:** 01/04/2017

## 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 |