Individual
MARGARET E BOLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
101 W 8TH AVE, SPOKANE, WA 99204-2307
(509) 474-4060
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(509) 474-2072
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI00001437
WA
133VN1004X
Pediatric Nutrition Registered Dietitian
DI00001437
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
807871900
ID MEDICAID
WA
01
—
DI00001437
LIC
WA
Enumeration date
10/02/2007
Last updated
10/19/2015
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