Provider Demographics
NPI:1326131830
Name:BOLLSTETTER, JUDY J (APRN, BC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:J
Last Name:BOLLSTETTER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4316
Mailing Address - Country:US
Mailing Address - Phone:989-583-2794
Mailing Address - Fax:989-583-2811
Practice Address - Street 1:515 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4727
Practice Address - Country:US
Practice Address - Phone:989-583-2794
Practice Address - Fax:989-583-2811
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704075682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI151144OtherGREAT LAKES HEALTH PLAN
MI5008754250OtherBCBSM
MI4704075682OtherLICENSE
MI4775840Medicaid
MI5008754250OtherBCBSM