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General NPI Number Information
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NPI Number | 1215666839
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Entity Type | Individual
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Provider Name | JILL T BOLDUC CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 55 FRUIT ST
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City | BOSTON
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State | MA
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Zip | 02114-2621
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Country | US
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Telephone | 617-726-8707
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Fax |
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Provider Business Mailing Address
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Address Line | 55 FRUIT ST BLDG 6TH
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City | BOSTON
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State | MA
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Zip | 02114-2696
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Country | US
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Telephone | 617-726-8707
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Fax | 978-857-4549
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 2308867
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2308867
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License Number State | MA
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