Provider Demographics
NPI:1124117122
Name:BOLSTER, ANJENEAN BEHOLD (RN, MSN, PNP)
Entity type:Individual
Prefix:
First Name:ANJENEAN
Middle Name:BEHOLD
Last Name:BOLSTER
Suffix:
Gender:F
Credentials:RN, MSN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1824
Mailing Address - Country:US
Mailing Address - Phone:303-413-7527
Mailing Address - Fax:
Practice Address - Street 1:3482 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1824
Practice Address - Country:US
Practice Address - Phone:303-413-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992751-NP363LP0200X
CORN.1643701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics