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Individual
DARAYU C BOLTAEVA
Active
Individual
DARAYU C BOLTAEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMS, PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
NULL
363AS0400X
Surgical Physician Assistant
Primary
8239
WI
Other
Enumeration date
12/16/2024
Last updated
04/01/2025
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