Provider Demographics
NPI:1124063847
Name:BOLETTE, CINDA JO
Entity type:Individual
Prefix:MRS
First Name:CINDA
Middle Name:JO
Last Name:BOLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 6TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-6530
Mailing Address - Country:US
Mailing Address - Phone:360-659-7003
Mailing Address - Fax:
Practice Address - Street 1:5439 6TH AVE NW
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-6530
Practice Address - Country:US
Practice Address - Phone:360-659-7003
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00058647183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician