Individual
KEVIN CHRISTOPHER BOLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CST/CSFA
Contact information
Practice address
1046 6TH AVE SW, ALBANY, OR 97321-1916
(541) 812-4000
Mailing address
11240 SE CRANBERRY LOOP, CLACKAMAS, OR 97015-8525
(971) 237-0159
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
187722
CO
246ZS0410X
Surgical Technologist
187722
CO
Other
Enumeration date
04/26/2019
Last updated
04/26/2019
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