Healthcare Provider Details

I. General information

NPI: 1275242851
Provider Name (Legal Business Name): GULMIRA BOLTAEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 AVENUE P APT 3B
BROOKLYN NY
11229-1354
US

IV. Provider business mailing address

1901 AVENUE P APT 3B
BROOKLYN NY
11229-1354
US

V. Phone/Fax

Practice location:
  • Phone: 347-543-5255
  • Fax:
Mailing address:
  • Phone: 347-543-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14922000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number755044
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF350545-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: