MEDICARE: MS. KARINA WEEKES BOLGER CD(DONA)

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1508178815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARINA WEEKES BOLGER CD(DONA)

Provider Business Mailing Address
First Line	:	16612 MALAGA HILLS DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5533
Country	:	US
Telephone Number	:	512-828-0514
Fax Number	:

Provider Business Practice Location Address
First Line	:	16612 MALAGA HILLS DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5533
Country	:	US
Telephone Number	:	512-828-0514
Fax Number	:

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

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/02/2010

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