Provider Demographics
NPI:1932585429
Name:BOLDEBUCK, LAUREN FAITH (ND)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:FAITH
Last Name:BOLDEBUCK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S PERRY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-3464
Mailing Address - Country:US
Mailing Address - Phone:509-598-8558
Mailing Address - Fax:
Practice Address - Street 1:1025 S PERRY ST
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3464
Practice Address - Country:US
Practice Address - Phone:509-598-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60559007175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath