1093742785 NPI number — PROF. JUDY A BOLTEN RN

Table of content: PROF. JUDY A BOLTEN RN (NPI 1093742785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093742785 NPI number — PROF. JUDY A BOLTEN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLTEN
Provider First Name:
JUDY
Provider Middle Name:
A
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1093742785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 817 BOX 32
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09622
Provider Business Mailing Address Country Code:
IT
Provider Business Mailing Address Telephone Number:
390815685973
Provider Business Mailing Address Fax Number:
81-568-5976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
P'SC 827 BOX 1000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09617
Provider Business Practice Location Address Country Code:
IT
Provider Business Practice Location Address Telephone Number:
390815686303
Provider Business Practice Location Address Fax Number:
390815685976
Provider Enumeration Date:
06/27/2006

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: 163WX0106X , with the licence number:  520414 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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