Provider Demographics
NPI:1275010571
Name:BOLTEN, BONNIE IRENE (LVN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:IRENE
Last Name:BOLTEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8961 FM 1094 RD
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474
Mailing Address - Country:US
Mailing Address - Phone:979-270-3394
Mailing Address - Fax:
Practice Address - Street 1:8961 FM 1094 RD
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474
Practice Address - Country:US
Practice Address - Phone:979-270-3394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221673164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse