MEDICARE: JONNA BOLT RN

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
1	163W00000X	Registered Nurse	976770	TX

General Provider Information

NPI Number	:	1538002936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONNA BOLT RN

Provider Business Mailing Address
First Line	:	13402 LUCKY BILL LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-1542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13402 LUCKY BILL LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-1542
Country	:	US
Telephone Number	:	832-882-2266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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