1093990020 NPI number — LOUISE M BOLTE CRNP

Table of content: LOUISE M BOLTE CRNP (NPI 1093990020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093990020 NPI number — LOUISE M BOLTE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLTE
Provider First Name:
LOUISE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRESSLER
Provider Other First Name:
LOUISE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093990020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 829641
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-370-5295
Provider Business Mailing Address Fax Number:
215-230-3725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
599 W STATE ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18901-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-893-6800
Provider Business Practice Location Address Fax Number:
267-896-6820
Provider Enumeration Date:
01/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  SP009611 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)