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General NPI Number Information
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NPI Number | 1720332372
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Entity Type | Individual
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Provider Name | KATRINA JO BOLDUC LM, CPM
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Gender | Female
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 61 5TH ST
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City | TEMPLETON
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State | CA
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Zip | 93465-5100
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Country | US
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Telephone | 805-748-2939
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Fax | 805-256-7326
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Provider Business Mailing Address
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Address Line | 5150 OLMEDA AVE
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City | ATASCADERO
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State | CA
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Zip | 93422-3324
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Country | US
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Telephone | 805-748-2939
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Fax | 805-265-7326
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | 673
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License Number State | CA
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