Individual
MR. KEVIN J BOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10828 GRAVELLY LAKE DR SW, LAKEWOOD, WA 98499-1334
(360) 436-6594
Mailing address
19414 126TH ST E, BONNEY LAKE, WA 98391-6063
(253) 740-3245
(253) 826-4972
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003177
WA
363AM0700X
Medical Physician Assistant
PA10003177
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188614
LABOR AND INDUSTRIES
WA
Enumeration date
02/09/2007
Last updated
12/03/2021
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