Healthcare Provider Details

I. General information

NPI: 1013912799
Provider Name (Legal Business Name): MURRITA C. BOLINGER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 WASHINGTON STREET
RAVENSWOOD WV
26164-1373
US

IV. Provider business mailing address

PO BOX 609
ELIZABETH WV
26143-0609
US

V. Phone/Fax

Practice location:
  • Phone: 304-273-1033
  • Fax: 304-273-1034
Mailing address:
  • Phone: 304-275-3301
  • Fax: 304-275-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38386
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: