Jeb Bolerjack, RN
Registered Nurse in Longview, WA. Individual provider (NPI-1).
NPI number1467940486
StatusActive
Last updated in NPPESJun 27, 2019
Details
- NPI
- 1467940486
- Entity type
- Individual (NPI-1)
- Name
- Jeb Bolerjack
- Credential
- RN
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 25, 2018
- Last updated
- Jun 27, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163W00000X | Registered Nurse | RN60344179 | WA | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | CP00005027 | WA |
Practice location
784 14th AveLongview, WA 98632-2315
Phone 360-703-6400 · Fax 360-353-3611
Mailing address
1057 12th AveLongview, WA 98632-2509
Phone 360-636-3892 · Fax 360-414-1342
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