Provider Demographics
NPI:1225415615
Name:BOLDERMAN, KAREN M (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:BOLDERMAN
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MARGARET
Other - Last Name:BOLDERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LDN, CDE
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8700
Mailing Address - Fax:352-674-8714
Practice Address - Street 1:1400 N US HIGHWAY 441
Practice Address - Street 2:SUUITE 810
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8975
Practice Address - Country:US
Practice Address - Phone:352-674-8700
Practice Address - Fax:352-674-8714
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7205133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered