Individual
JUSTINA M BOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD00042181
WA
208M00000X
Hospitalist Physician
Primary
MD00042181
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760418339
—
WA
01
—
P01428115
RR PTAN
WA
Enumeration date
06/24/2006
Last updated
07/13/2020
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