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Individual
JEB BOLERJACK
Active
Individual
JEB BOLERJACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP00005027
WA
163W00000X
Registered Nurse
Primary
RN60344179
WA
Other
Enumeration date
04/25/2018
Last updated
06/27/2019
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