Individual
BRENT M DEBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
2314 E 13TH ST, VANCOUVER, WA 98661-4122
(503) 709-7122
Mailing address
2314 E 13TH ST, VANCOUVER, WA 98661-4122
(503) 709-7122
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60203433
WA
Other
Enumeration date
01/20/2011
Last updated
01/20/2011
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