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Individual
JUDY J BOLLSTETTER
Active
Individual
JUDY J BOLLSTETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704075682
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151144
GREAT LAKES HEALTH PLAN
MI
01
—
4704075682
LICENSE
MI
05
—
4775840
—
MI
01
—
5008754250
BCBSM
MI
Enumeration date
10/02/2006
Last updated
09/12/2007
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