Provider Demographics
NPI:1417964222
Name:BOELTER, CAROL A (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:BOELTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7001 A ST
Mailing Address - Street 2:STE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4205
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:2200 S 40TH ST
Practice Address - Street 2:STE 104
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2407
Practice Address - Country:US
Practice Address - Phone:402-483-6000
Practice Address - Fax:402-483-6106
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE24583OtherMIDLAND'S CHOICE
NE00210OtherBCBS
NE01-03334OtherUHC
NE00210OtherBCBS
NE275566Medicare PIN