=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326131830
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDY J BOLLSTETTER APRN, BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 09/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 N MICHIGAN AVE
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-4727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-583-2794
-----------------------------------------------------
Fax | 989-583-2811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 N MICHIGAN AVE
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-583-2794
-----------------------------------------------------
Fax | 989-583-2811
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 4704075682
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------