Individual
JUSTIN BOLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-7921
(314) 251-4815
Mailing address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-7921
(314) 251-4815
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
2015024051
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015024051
MISSOURI STATE BOARD OF NURSING
MO
01
—
21800005
NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS
—
Enumeration date
05/02/2018
Last updated
05/02/2018
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