MEDICARE: CINDY ANN BOLTER PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN336646	CA
2	363LF0000X	Family Nurse Practitioner	17440	CA
3	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	RN336646	CA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	17440	CA

General Provider Information

NPI Number	:	1245459544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY ANN BOLTER PMHNP-BC

Provider Business Mailing Address
First Line	:	2970 CAMINO DIABLO STE 300
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-4001
Country	:	US
Telephone Number	:	925-282-1778
Fax Number	:	415-296-5299

Provider Business Practice Location Address
First Line	:	2970 CAMINO DIABLO STE 300
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-4001
Country	:	US
Telephone Number	:	925-282-1778
Fax Number	:	415-296-5299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	04/10/2024

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