Healthcare Provider Details

I. General information

NPI: 1588841035
Provider Name (Legal Business Name): KATHRYN DORWEILER BOLT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 6250
DENVER CO
80218-1291
US

IV. Provider business mailing address

1601 E 19TH AVE STE 6250
DENVER CO
80218-1291
US

V. Phone/Fax

Practice location:
  • Phone: 303-563-2755
  • Fax: 303-861-6219
Mailing address:
  • Phone: 303-563-2755
  • Fax: 303-861-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2729
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: