Healthcare Provider Details

I. General information

NPI: 1053254375
Provider Name (Legal Business Name): ALEKSANDRA NIKOLAYEVNA BOLTUNOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 W CRAIG RD STE 220
NORTH LAS VEGAS NV
89032-0329
US

IV. Provider business mailing address

1550 W CRAIG RD STE 220
NORTH LAS VEGAS NV
89032-0329
US

V. Phone/Fax

Practice location:
  • Phone: 702-616-5801
  • Fax:
Mailing address:
  • Phone: 702-616-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: