Provider Demographics
NPI:1558146530
Name:BOLME, TREVOR M
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:M
Last Name:BOLME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3113
Mailing Address - Country:US
Mailing Address - Phone:303-513-9111
Mailing Address - Fax:
Practice Address - Street 1:402 1ST ST NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3113
Practice Address - Country:US
Practice Address - Phone:303-513-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator