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NPI Code Detail

MEDICARE: ANJENEAN BEHOLD BOLSTER RN, MSN, PNP

MEDICARE: ANJENEAN BEHOLD BOLSTER RN, MSN, PNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse PractitionerAPN.0992751-NPCO
2163W00000XRegistered NurseRN.1643701CO

General Provider Information

NPI Number : 1124117122
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANJENEAN BEHOLD BOLSTER RN, MSN, PNP
Provider Business Mailing Address
First Line : 3450 BROADWAY ST
Second Line :
City : BOULDER
State : CO
Zip : 80304-1824
Country : US
Telephone Number : 303-413-7527
Fax Number :
Provider Business Practice Location Address
First Line : 3482 BROADWAY ST
Second Line :
City : BOULDER
State : CO
Zip : 80304-1824
Country : US
Telephone Number : 303-413-7527
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 11/07/2019

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