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General NPI Number Information
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NPI Number | 1356206890
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Entity Type | Organization
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Legal Business Name | THE FAIRY TOX-MOTHER INC.
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 2401 VISTA WAY SUITE A
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City | OCEANSIDE
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State | CALIFORNIA
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Zip | 92056
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Country | UM
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 3913 CAMEO DR
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City | OCEANSIDE
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State | CALIFORNIA
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Zip | 92056
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Country | UM
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMELY MARIE BOLSTON
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Credential | NP
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Telephone | 442-202-4635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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