Provider Demographics
NPI:1083915789
Name:BOLTZ, CYNTHIA ELAINE
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:BOLTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ELAINE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:109 PUGH ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:SD
Mailing Address - Zip Code:57551-7700
Mailing Address - Country:US
Mailing Address - Phone:605-685-6868
Mailing Address - Fax:866-423-6811
Practice Address - Street 1:109 PUGH ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:SD
Practice Address - Zip Code:57551-7700
Practice Address - Country:US
Practice Address - Phone:605-685-6868
Practice Address - Fax:866-423-6811
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily