Healthcare Provider Details

I. General information

NPI: 1093742785
Provider Name (Legal Business Name): JUDY A BOLTEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

P'SC 827 BOX 1000
FPO AE
09617
IT

IV. Provider business mailing address

PSC 817 BOX 32
FPO AE
09622
IT

V. Phone/Fax

Practice location:
  • Phone: 390815686303
  • Fax: 390815685976
Mailing address:
  • Phone: 390815685973
  • Fax: 81-568-5976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number520414
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: