Healthcare Provider Details

I. General information

NPI: 1881606713
Provider Name (Legal Business Name): LAURIE A. BOLT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GREENFIELD AVE
HANFORD CA
93230-3513
US

IV. Provider business mailing address

2100 POWELL ST SUITE 900
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-9000
  • Fax:
Mailing address:
  • Phone: 510-350-2664
  • Fax: 510-879-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP12024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: