Individual
TARA WULFF BOLKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
506 4TH ST, LA GRANDE, OR 97850-1906
(541) 663-3138
(541) 975-5120
Mailing address
PO BOX 3290, LA GRANDE, OR 97850-7290
(541) 663-7313
(541) 975-5120
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1-089967
AL
363LF0000X
Family Nurse Practitioner
Primary
201910351NP-PP
OR
363LF0000X
Family Nurse Practitioner
203981
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500773203
—
OR
Enumeration date
04/07/2017
Last updated
03/06/2024
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