Provider Demographics
NPI:1114491461
Name:BOLTON, BRITTANY JOANNE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JOANNE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:812 MOHAWK DRIVE
Practice Address - Street 2:
Practice Address - City:MCDERMOTT
Practice Address - State:OH
Practice Address - Zip Code:45652
Practice Address - Country:US
Practice Address - Phone:740-356-6030
Practice Address - Fax:740-356-6033
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023784363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner