Individual
BAILEY N. BOLTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3801 5TH ST SE STE 110, PUYALLUP, WA 98374-2106
(253) 845-9585
Mailing address
3801 5TH ST SE STE 110, PUYALLUP, WA 98374-2106
(253) 845-9585
(253) 848-1126
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA61101539
WA
363AS0400X
Surgical Physician Assistant
Primary
PA61101539
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2171601
—
WA
Enumeration date
11/07/2020
Last updated
08/18/2022
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