Individual provider · Type 1 NPI

Polina Kokoulina, PA-C

Surgical Physician Assistant · Boise, ID

NPI number 1013342468 Active

Practice location

900 N Liberty St, Ste 101
Boise, ID 83704-8704

Call (208) 367-5050 Map

Fax (208) 367-5151

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400XPA-1093 (ID)

Surgical Physician Assistant: Definition to come...

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About NPI 1013342468

Polina Kokoulina, PA-C's National Provider Identifier is 1013342468, issued on Sep 4, 2013. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Boise, ID. The record was last updated on Apr 6, 2015.