Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RP1001X | Pulmonary Disease | DR.0051870 | CO |
Y | 207RS0012X | Sleep Medicine | DR.0051870 | CO |
NPI | 1003076159 |
---|---|
Provider Name | Evelyn Yoh Bolt |
First Address | Lafayette, CO 80026-8701 |
Second Address | Broomfield, CO 80023-3606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 10/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370941YWN5 | MEDICARE PTAN (01) | CO |