Provider Demographics
NPI:1811389034
Name:BOLDUC, CHRISTINA ANDI (RN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ANDI
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:ANDI
Other - Last Name:MACIARIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12871-1019
Mailing Address - Country:US
Mailing Address - Phone:518-695-3255
Mailing Address - Fax:518-695-6405
Practice Address - Street 1:14 SPRING ST
Practice Address - Street 2:
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871-1019
Practice Address - Country:US
Practice Address - Phone:518-695-3255
Practice Address - Fax:518-695-6405
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY681693163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse