Healthcare Provider Details

I. General information

NPI: 1447562335
Provider Name (Legal Business Name): LADY-THELMA W BOLDUC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WINTER ST
BOSTON MA
02108-4720
US

IV. Provider business mailing address

30 WINTER ST
BOSTON MA
02108-4720
US

V. Phone/Fax

Practice location:
  • Phone: 617-426-0660
  • Fax:
Mailing address:
  • Phone: 617-426-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2283758
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2283758
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: