Provider Demographics
NPI:1720252976
Name:BOLSTER, SANDRA B (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:B
Last Name:BOLSTER
Suffix:
Gender:F
Credentials:RN
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Other - Last Name:
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Mailing Address - Street 1:1222 10TH STREET
Mailing Address - Street 2:SUITE 211 NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3156
Mailing Address - Country:US
Mailing Address - Phone:405-282-1830
Mailing Address - Fax:405-282-1861
Practice Address - Street 1:1923 S DIVISION
Practice Address - Street 2:NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044
Practice Address - Country:US
Practice Address - Phone:405-282-1830
Practice Address - Fax:405-282-1861
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18819163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse