Healthcare Provider Details

I. General information

NPI: 1528453198
Provider Name (Legal Business Name): ERIKA BOLTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TAYLOR RD SUITE 3380
MONTGOMERY AL
36117-3512
US

IV. Provider business mailing address

3216 BROWNS RD
MILLBROOK AL
36054-2421
US

V. Phone/Fax

Practice location:
  • Phone: 334-213-6255
  • Fax:
Mailing address:
  • Phone: 205-535-5516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-113709
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: