Provider Demographics
NPI:1144728015
Name:BOHLMAN, RYAN L (RN)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:BOHLMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15309 64TH ST E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3606
Mailing Address - Country:US
Mailing Address - Phone:253-579-3038
Mailing Address - Fax:
Practice Address - Street 1:15309 64TH ST E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3606
Practice Address - Country:US
Practice Address - Phone:253-579-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60718162163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse