Provider Demographics
NPI:1629571880
Name:BOLTON, MARCUS PAUL (CNP)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:PAUL
Last Name:BOLTON
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 N MONROE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1699
Mailing Address - Country:US
Mailing Address - Phone:937-374-3484
Mailing Address - Fax:937-374-7484
Practice Address - Street 1:1157 N MONROE DR STE 220
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1699
Practice Address - Country:US
Practice Address - Phone:937-374-3484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily