Individual
JACQUELINE BOLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1157 S CRISMON RD, MESA, AZ 85208-2661
(480) 776-3790
Mailing address
14247 S 47TH PL, PHOENIX, AZ 85044-6206
(480) 521-3825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/18/2021
Last updated
01/10/2022
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