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General NPI Number Information
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NPI Number | 1003626060
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Entity Type | Individual
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Provider Name | TRISHA BOLTJES
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Gender | Female
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Dates
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Enumeration Date | 01/11/2025
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 58850 8685 RD
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City | WATERBURY
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State | NE
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Zip | 68785-3023
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Country | US
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Telephone | 402-404-0710
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 28TH ST SPC 149
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City | SIOUX CITY
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State | IA
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Zip | 51105-2377
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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