Individual
NICOLE R MERCER BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1990 CONNECTICUT AVE S, SARTELL, MN 56377-2554
(320) 257-5595
(320) 257-5596
Mailing address
PO BOX 7366, SAINT CLOUD, MN 56302-7366
(320) 257-5595
(320) 257-5596
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
53816
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881890549
—
MN
Enumeration date
06/21/2007
Last updated
09/22/2011
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