IndividualActive
Polina Kokoulina, PA-C
NPI 1013342468 · Surgical Physician Assistant · Boise, ID
Provider details
- NPI number
- 1013342468
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- License
- PA-1093 (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
900 N Liberty St
Ste 101
Boise, ID 83704-8704
Phone: (208) 367-5050
Fax: (208) 367-5151
Approximate (ZIP-level) locationGet directions
Mailing address
3340 E Goldstone Way
Meridian, ID 83642-1026
Registry dates
- Enumerated
- 2013-09-04
- Last updated
- 2015-04-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.