MEDICARE: VALERIE BOLTON PNP

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	363LA2100X	Acute Care Nurse Practitioner	06445	LA

General Provider Information

NPI Number	:	1568754885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE BOLTON PNP

Provider Business Mailing Address
First Line	:	201 4TH STREET
Second Line	:	SUITE 5B
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-0000
Country	:	US
Telephone Number	:	318-769-3501
Fax Number	:	318-769-3502

Provider Business Practice Location Address
First Line	:	201 4TH STREET
Second Line	:	SUITE 5B
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-0000
Country	:	US
Telephone Number	:	318-769-3501
Fax Number	:	318-769-3502

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	08/03/2011

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