Healthcare Provider Details

I. General information

NPI: 1407241946
Provider Name (Legal Business Name): ERIN BOLDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CALLE ARMADA
ESPANOLA NM
87532-3460
US

IV. Provider business mailing address

905 CALLE ARMADA
ESPANOLA NM
87532-3460
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-0505
  • Fax:
Mailing address:
  • Phone: 505-753-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number944
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: