Healthcare Provider Details

I. General information

NPI: 1033678958
Provider Name (Legal Business Name): MONICA R BUBOLTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N JEFFERSON ST
NEW ULM MN
56073-1933
US

IV. Provider business mailing address

614 N JEFFERSON ST
NEW ULM MN
56073-1933
US

V. Phone/Fax

Practice location:
  • Phone: 507-217-6016
  • Fax:
Mailing address:
  • Phone: 507-217-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255R0406X
TaxonomyBlind Rehabilitation Specialist/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: