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Individual

SHANNON ELOISE BOLT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
4209 TIETON DR, YAKIMA, WA 98908-3377
(509) 654-9810
(509) 966-8812
Mailing address
4209 TIETON DR, YAKIMA, WA 98908-3377
(509) 654-9810
(509) 966-8812

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60528267
WA
363LF0000X
Family Nurse Practitioner
Primary
AP61369683
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AP61369683
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
01
F10220605
AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD
01
RN60528267
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
02/20/2015
Last updated
11/21/2022
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