Healthcare Provider Details

I. General information

NPI: 1326131830
Provider Name (Legal Business Name): JUDY J BOLLSTETTER APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N MICHIGAN AVE
SAGINAW MI
48602-4727
US

IV. Provider business mailing address

515 N MICHIGAN AVE
SAGINAW MI
48602-4316
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-2794
  • Fax: 989-583-2811
Mailing address:
  • Phone: 989-583-2794
  • Fax: 989-583-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704075682
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: