NPI 1013342468

Polina Kokoulina, PAC

Practitioner Surgical Physician Assistant Boise, ID

Practice location

Address: 900 N Liberty St STE 101, Boise, ID 83704-8704
Phone: (208) 367-5050
Fax: (208) 367-5151
Mailing address: 3340 E Goldstone Way, Meridian, ID 83642-1026

Registered specialties

Surgical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AS0400X Licence PA-1093 (ID)

Other Physician Assistant providers in Idaho →

Registry record

NPI: 1013342468
Entity type: Individual
Sex (as registered): Female
NPI issued: 4 Sep 2013
Record last updated: 6 Apr 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.