Individual
SARAH LEE DEVERA BOLANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
9040 JACKSON AVE ATTN: MCHJ-CLQ-C, TACOMA, WA 98431-0001
(253) 968-1110
Mailing address
11612 185TH STREET CT E, PUYALLUP, WA 98374-6464
(951) 902-5351
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95027622
CA
Other
Enumeration date
04/26/2018
Last updated
03/29/2024
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