Provider Demographics
NPI:1841657236
Name:BOLICK, KATE ELIZABETH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KATE
Middle Name:ELIZABETH
Last Name:BOLICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 W DALE ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1925
Mailing Address - Country:US
Mailing Address - Phone:319-235-5060
Mailing Address - Fax:319-235-5061
Practice Address - Street 1:152 W DALE ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1925
Practice Address - Country:US
Practice Address - Phone:319-235-5060
Practice Address - Fax:319-235-5061
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA114716363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner