| Sarah Lee Devera Bolanos, REGISTERED NURSE | |
|
9040 Jackson Ave Attn: Mchj-clq-c, Tacoma, WA 98431-0001 | |
| (253) 968-1110 | |
| Not Available |
| Full Name | Sarah Lee Devera Bolanos |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 9040 Jackson Ave Attn: Mchj-clq-c, Tacoma, Washington |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598253338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 95027622 (California) | Primary |
| Entity Name | Universal Care |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1376632877 PECOS PAC ID: 2365332368 Enrollment ID: O20040315001597 |
| Entity Name | Molina Healthcare Of California |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1194811760 PECOS PAC ID: 7517957608 Enrollment ID: O20061101000348 |
| Entity Name | Central Health Plan Of California, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1386714772 PECOS PAC ID: 7416395736 Enrollment ID: O20240405001559 |
| Mailing Address | Practice Location Address |
|---|---|
| Sarah Lee Devera Bolanos, REGISTERED NURSE 11612 185th Street Ct E, Puyallup, WA 98374-6464 Ph: (951) 902-5351 | Sarah Lee Devera Bolanos, REGISTERED NURSE 9040 Jackson Ave Attn: Mchj-clq-c, Tacoma, WA 98431-0001 Ph: (253) 968-1110 |
Salome Odja Dockendorf, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1201 Pacific Ave Ste 19501201, Tacoma, WA 98402 Phone: 812-870-6728 | |
Barbara L Kapuscinski, ARNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 9040 Jackson Ave, Tacoma, WA 98431 Phone: 253-968-2751 | |
Ms. Christine J. Larsen, ARNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3580 Pacific Ave, Tacoma, WA 98418 Phone: 253-798-4500 Fax: 253-798-4493 | |
Rick Hahn, ARNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 315 Martin Luther King Jr Way, Tacoma, WA 98405 Phone: 253-403-1000 | |
Mrs. Kimberley Anne Burns, APRN,BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1617 S J St, Tacoma, WA 98405 Phone: 253-274-7504 | |
Randi Marie Berg, ARNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 9040 Reid St, Tacoma, WA 98431 Phone: 253-968-2315 | |
Marlene I Bridgforth, ARNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1901 S Cedar St, #301 Cardiac Study Center Inc Ps, Tacoma, WA 98405 Phone: 253-572-7320 Fax: 253-627-3191 |