Healthcare Provider Details

I. General information

NPI: 1609051226
Provider Name (Legal Business Name): KAREN E BOLHUIS MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 CHOUTEAU AVE NESTLE PURINA PETCARE COMPANY, MEDICAL DEPT LLT
SAINT LOUIS MO
63102-1009
US

IV. Provider business mailing address

NESTLE PURINA PETCARE COMPANY CHECKERBOARD SQUARE, MEDICAL DEPT LLT
SAINT LOUIS MO
63164-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-982-1230
  • Fax: 314-982-3486
Mailing address:
  • Phone: 314-982-1230
  • Fax: 314-982-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number153090
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: