Provider Demographics
NPI:1922756980
Name:BOLTZ, EMILY NADINE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NADINE
Last Name:BOLTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W NEW INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-2494
Mailing Address - Country:US
Mailing Address - Phone:630-966-4000
Mailing Address - Fax:
Practice Address - Street 1:309 W NEW INDIAN TRL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2494
Practice Address - Country:US
Practice Address - Phone:630-966-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator