Provider Demographics
NPI:1720300908
Name:BOLSTER, SARAH J
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:BOLSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:MACURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:38H HUNTER BROOK LN
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-5858
Mailing Address - Country:US
Mailing Address - Phone:518-926-8925
Mailing Address - Fax:
Practice Address - Street 1:38H HUNTER BROOK LN
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5858
Practice Address - Country:US
Practice Address - Phone:518-926-8925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256010-1164W00000X
NY256010164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse