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NPI Code Detail

MEDICARE: MARYANNE BOLT APRN

MEDICARE: MARYANNE BOLT APRN
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
1363L00000XNurse Practitioner98345OK

General Provider Information

NPI Number : 1912378050
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYANNE BOLT APRN
Provider Business Mailing Address
First Line : 2488 E 81ST ST STE 2000
Second Line :
City : TULSA
State : OK
Zip : 74137-4224
Country : US
Telephone Number : 918-592-9020
Fax Number : 918-481-4709
Provider Business Practice Location Address
First Line : 2488 E 81ST ST STE 2000
Second Line :
City : TULSA
State : OK
Zip : 74137-4224
Country : US
Telephone Number : 918-481-4700
Fax Number : 918-592-2020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2015
Last Update Date : 05/09/2025

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Directions to “ MARYANNE BOLT APRN” Practice Location

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