Provider Demographics
NPI:1649327123
Name:NOLTE, VIRGIE BAY (EDD)
Entity type:Individual
Prefix:DR
First Name:VIRGIE
Middle Name:BAY
Last Name:NOLTE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 STATE HWY 47
Mailing Address - Street 2:STE 4300
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-3235
Mailing Address - Country:US
Mailing Address - Phone:979-776-4035
Mailing Address - Fax:979-776-4251
Practice Address - Street 1:8441 STATE HWY 47
Practice Address - Street 2:STE 4300
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-3235
Practice Address - Country:US
Practice Address - Phone:979-776-4035
Practice Address - Fax:979-776-4251
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22599103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
00D94RMedicare PIN
R57618Medicare UPIN