Provider Demographics
NPI:1013912799
Name:BOLINGER, MURRITA C (CFNP)
Entity type:Individual
Prefix:
First Name:MURRITA
Middle Name:C
Last Name:BOLINGER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0609
Mailing Address - Country:US
Mailing Address - Phone:304-275-3301
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:606 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1373
Practice Address - Country:US
Practice Address - Phone:304-273-1033
Practice Address - Fax:304-273-1034
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7102007000Medicaid
WVBO2030261Medicare PIN
BONP05603Medicare ID - Type Unspecified
WV7102007000Medicaid