Provider Demographics
NPI:1790384360
Name:BOLZMAN, SONDRA R (MIDWIFE CPM)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:R
Last Name:BOLZMAN
Suffix:
Gender:F
Credentials:MIDWIFE CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4861 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48746-9671
Mailing Address - Country:US
Mailing Address - Phone:989-871-4863
Mailing Address - Fax:
Practice Address - Street 1:4861 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:MI
Practice Address - Zip Code:48746-9671
Practice Address - Country:US
Practice Address - Phone:989-871-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000023175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay